Individual
LAUREN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
417 S INDIANA AVE, TRINIDAD, CO 81082-3126
(719) 545-2746
(719) 542-9638
Mailing address
41 MONTEBELLO RD STE 202, PUEBLO, CO 81001-1366
(719) 545-2746
(719) 542-9638
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/06/2018
Last updated
09/06/2018
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