Nissa Nichole Wilson

NPI #1245904051 in Fort Gratiot, Michigan

Provider Information

NPI Number: 1245904051
Entity Type: Individual
Name: Nissa Nichole Wilson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Behavior Technician
Enumeration Date: Aug 4, 2021
Last Updated: Aug 4, 2021

Practice Location

Address: 3245 KEEWAHDIN RD
City: Fort Gratiot
State: Michigan
ZIP Code: 48059-3498
Phone: (810) 937-2345

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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