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Individual

MARISSA WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
B.A.

Contact information

Practice address
6925 BARRIE LYNN ST, HAMMOND, IN 46323-2476
(708) 257-6335
Mailing address
6925 BARRIE LYNN ST, HAMMOND, IN 46323-2476

Taxonomy

Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary

Other

Enumeration date
11/07/2013
Last updated
11/07/2013
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