Individual
JACKSON WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
82 KELLY MARIE DR, PATASKALA, OH 43062-8182
(614) 315-9437
Mailing address
82 KELLY MARIE DR, PATASKALA, OH 43062-8182
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/09/2024
Last updated
01/09/2024
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