Individual
JACQUELINE S WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
321 E MAIN ST, SUITE 309, BOZEMAN, MT 59715-6241
(406) 586-7515
(406) 522-0481
Mailing address
321 E MAIN ST, SUITE 309, BOZEMAN, MT 59715-6241
(406) 586-7515
(406) 522-0481
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
8315
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0152425
—
MT
01
—
93296
BCBS
MT
Enumeration date
06/09/2006
Last updated
03/17/2008
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