Individual
MATIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
510 S CACHE ST, JACKSON, WY 83001-8693
(307) 733-6440
Mailing address
PO BOX 132, WILSON, WY 83014-0132
(307) 690-2983
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1205
WY
Other
Enumeration date
06/15/2017
Last updated
10/21/2020
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