Individual
JAYLEN MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4610 HANNA ST, FORT WAYNE, IN 46806-2302
(260) 602-4719
Mailing address
4610 HANNA ST, FORT WAYNE, IN 46806-2302
(260) 602-4719
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
05/08/2024
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