Individual
AMY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC-I
Contact information
Practice address
2555 MAIN ST, KLAMATH FALLS, OR 97601-2723
(541) 883-2795
(541) 883-8194
Mailing address
2555 MAIN ST, KLAMATH FALLS, OR 97601-2723
(541) 883-2795
(541) 883-8194
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10-03-37
OR
Other
Enumeration date
07/12/2010
Last updated
07/12/2010
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