Individual
JASON EDWARD WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
213 NE 10TH ST, MCMINNVILLE, OR 97128-4825
(971) 261-2259
Mailing address
627 NE EVANS ST, MCMINNVILLE, OR 97128-3923
(503) 434-7527
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/29/2020
Last updated
02/17/2020
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