Individual
LACIE MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7610 E PALMER WASILLA HWY, PALMER, AK 99645-8467
(907) 206-4421
(907) 726-5366
Mailing address
3344 W DISCOVERY LOOP, WASILLA, AK 99654-1277
(907) 232-2797
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/11/2023
Last updated
07/11/2023
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