Individual
ANGELA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2141 SPENCER CT, LA GRANGE, KY 40031-6742
(502) 589-8600
(502) 589-8745
Mailing address
101 W MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1423
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
1
KY
Other
Enumeration date
11/21/2007
Last updated
04/20/2015
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