Individual
JACKALYNN LEE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
118 AMITY AVE, OLD FORGE, PA 18518-1019
(570) 905-0669
Mailing address
118 AMITY AVE, OLD FORGE, PA 18518-1019
(570) 905-0669
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC011549
PA
Other
Enumeration date
07/14/2019
Last updated
02/17/2026
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