Individual
ANDREA CLARE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17-05-48
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
A12828
OR
1041C0700X
Clinical Social Worker
Primary
L16483
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500700231
MEDICAID
OR
05
—
500787454
—
OR
Enumeration date
02/02/2016
Last updated
07/24/2025
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