Individual
EMILY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
27991 CENTER RIDGE RD, WESTLAKE, OH 44145-3902
(440) 455-3230
Mailing address
805 E WASHINGTON ST STE 130, MEDINA, OH 44256-3331
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881101780
—
TX
Enumeration date
08/10/2020
Last updated
02/15/2022
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