Individual
MR. TODD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
5101 BOARSHEAD RD, APT #117, MINNETONKA, MN 55345-4042
(763) 772-2262
Mailing address
5101 BOARSHEAD RD, APT #117, MINNETONKA, MN 55345-4042
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303526
MN
Other
Enumeration date
08/27/2015
Last updated
08/27/2015
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