Dominique Wilson
NPI #1083369490 in Chisago City, Minnesota
Provider Information
- NPI Number
- 1083369490
- Entity Type
- Individual
- Name
- Dominique Wilson
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Counselor - Professional
- Enumeration Date
- Feb 14, 2022
- Last Updated
- Feb 14, 2022
Practice Location
- Address
- 11185 LAKE BLVD STE 205
- City
- Chisago City
- State
- Minnesota
- ZIP Code
- 55013-9814
- Phone
- (952) 228-3487
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Professional — Professional |
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