Individual
RYAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 W MOCKINGBIRD LN STE 1030, DALLAS, TX 75247-5028
(248) 227-2980
Mailing address
1111 W MOCKINGBIRD LN STE 1030, DALLAS, TX 75247-5028
(972) 489-5552
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/12/2020
Last updated
10/12/2020
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