Individual
STACY CAYE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
223 LETSCH RD, WATERLOO, IA 50701-1748
(319) 382-0480
Mailing address
223 LETSCH RD, WATERLOO, IA 50701-1748
(319) 382-0480
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
088110
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27-2501300
—
IA
Enumeration date
09/08/2017
Last updated
08/18/2023
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