Individual
MICHELLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
(208) 706-0217
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2616
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-36744
ID
Other
Enumeration date
06/13/2017
Last updated
06/13/2017
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