Individual
JACQUELINE N WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
8171 N IRON HORSE DR, LAKE POINT, UT 84074-3496
(208) 881-2058
Mailing address
8171 N IRON HORSE DR, LAKE POINT, UT 84074-3496
(208) 881-2058
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
07/17/2025
Last updated
07/17/2025
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