Individual
JOSCELYN R. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
9911 SE MOUNT SCOTT BLVD, PORTLAND, OR 97266-6302
(503) 258-4200
Mailing address
9911 SE MOUNT SCOTT BLVD, PORTLAND, OR 97266-6302
(503) 258-4200
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
29062
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/10/2012
Last updated
12/01/2021
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