Individual
KANDYCE IVORY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1692 LAKEVIEW AVE, ROCKY RIVER, OH 44116-2443
(216) 760-3563
Mailing address
1692 LAKEVIEW AVE, ROCKY RIVER, OH 44116-2443
(216) 760-3563
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/20/2021
Last updated
01/20/2021
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