Individual
MR. KENNETH JEROME WILSON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5 LAVENDER LN, SPRINGFIELD, MA 01129-1708
(413) 315-7689
Mailing address
5 LAVENDER LN, SPRINGFIELD, MA 01129-1708
(413) 315-7689
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/19/2016
Last updated
01/19/2016
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