Individual
AMANDA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
575 WILLARD AVE SE, WARREN, OH 44483-6241
(330) 979-7112
Mailing address
575 WILLARD AVE SE, WARREN, OH 44483-6241
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/16/2024
Last updated
10/16/2024
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