Individual
JEROME LAMON WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2750 E WASHINGTON BLVD, PASADENA, CA 91107-1448
(626) 296-8900
Mailing address
406 W BROADWAY, SAN GABRIEL, CA 91776-1207
(626) 421-1030
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
CA
172V00000X
Community Health Worker
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
CA
Other
Enumeration date
01/23/2023
Last updated
05/05/2025
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