Individual
DENNIS WAYNE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1020 ELLINGTON DR, MILAN, TN 38358-3150
(731) 431-0609
Mailing address
728 BLACKMON STREET, MEDINA, TN 38355-6829
(731) 431-0609
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000001010
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36815541
—
TN
Enumeration date
06/08/2006
Last updated
06/08/2011
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