Individual
DR. ROBERT NICHOLI WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
403 JACKSON ST, SUITE 308, ANOKA, MN 55303-2372
(763) 786-9822
(763) 786-7749
Mailing address
403 JACKSON ST, SUITE 308, ANOKA, MN 55303-2372
(763) 786-9822
(763) 786-7749
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP-0869
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106960
U-CARE BOB
MN
01
—
61-69554
UBH # BOB
MN
01
—
8L409WI
BCBS BOB
MN
Enumeration date
12/23/2006
Last updated
07/09/2007
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