Crystal Rae Wilson

NPI #1477279446 in Shade, Ohio

Provider Information

NPI Number: 1477279446
Entity Type: Individual
Name: Crystal Rae Wilson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Oct 12, 2022
Last Updated: Oct 12, 2022

Practice Location

Address: 40328 BURLINGHAM RD
City: Shade
State: Ohio
ZIP Code: 45776-9505
Phone: (740) 590-9205

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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