Individual
RYAN JAMES WILKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1275 N 400 E APT F, RUPERT, ID 83350-8549
(801) 228-7082
Mailing address
1275 N 400 E APT F, RUPERT, ID 83350-8549
(801) 228-7082
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CADC-5082
ID
101YM0800X
Mental Health Counselor
Primary
LMSW-45129
ID
Other
Enumeration date
12/16/2024
Last updated
12/16/2024
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