Individual
JEDEDIAH HEATH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MED, LPC, NCC
Contact information
Practice address
5501 DELMAR BLVD STE B300, SAINT LOUIS, MO 63112-3078
(314) 469-4908
Mailing address
6705 PARKWOOD PL, SAINT LOUIS, MO 63116-2153
(312) 513-0239
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2022014908
MO
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
03/21/2022
Last updated
09/09/2024
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