Individual
WANDA L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6615 S ACACIA ST, BOISE, ID 83709-6683
(208) 918-4894
Mailing address
6615 S ACACIA ST, BOISE, ID 83709-6683
(208) 918-4894
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCSW-45394
ID
1041C0700X
Clinical Social Worker
Primary
45394
ID
Other
Enumeration date
02/12/2013
Last updated
06/25/2025
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