Jackie Ray Wilson

NPI #1831835107 in Stroud, Oklahoma

Provider Information

NPI Number: 1831835107
Entity Type: Individual
Name: Jackie Ray Wilson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Peer Specialist
Enumeration Date: May 10, 2022
Last Updated: Dec 16, 2022

Practice Location

Address: 119 W 2ND ST
City: Stroud
State: Oklahoma
ZIP Code: 74079-4011
Phone: (405) 328-1549

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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