Individual
DIANE RAE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
60805 29 PALMS HWY, JOSHUA TREE, CA 92252-5901
(760) 974-5990
Mailing address
60805 29 PALMS HWY, JOSHUA TREE, CA 92252-5901
(760) 974-5990
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
04/17/2025
Last updated
05/05/2025
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