Individual
STACEY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 AIRPORT RD #366, MOUNTAIN VILLAGE, AK 99632
(907) 591-6295
Mailing address
PO BOX 32366, MOUNTAIN VILLAGE, AK 99632-0366
(907) 591-6295
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
251B00000X
Case Management Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
08/08/2011
Last updated
08/08/2011
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