Individual
TA'AQUA J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3062 E 91ST ST, CHICAGO, IL 60617-4401
(773) 437-4643
Mailing address
3062 E 91ST ST, CHICAGO, IL 60617-4401
(773) 437-4643
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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