Individual
TIANA YVONNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1411 LINCOLNWAY W, MISHAWAKA, IN 46544-1626
(574) 533-1234
Mailing address
PO BOX 809, GOSHEN, IN 46527-0809
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
33011759A
IN
Other
Enumeration date
02/29/2024
Last updated
02/29/2024
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