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Individual

VANESSA WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
9001 E BLOOMINGTON FWY STE 143, BLOOMINGTON, MN 55420-3444
(952) 777-2004
Mailing address
9001 E BLOOMINGTON FWY STE 143, BLOOMINGTON, MN 55420-3444
(952) 777-2004

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1962881219
MN
05
474014022
MN
Enumeration date
07/16/2019
Last updated
07/16/2019
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