Individual
DR. PENNIE F WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHP-C
Contact information
Practice address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
Mailing address
10700 SW BEAVERTON HILLSDALE HWY STE 11, BEAVERTON, OR 97005-3035
(503) 446-1101
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/28/2012
Last updated
04/07/2020
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