MR. Jerry Wilson
NPI #1962731786 in Shiprock, New Mexico
Provider Information
- NPI Number
- 1962731786
- Entity Type
- Individual
- Name
- MR. Jerry Wilson
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Counselor - Addiction (Substance Use Disorder)
- Enumeration Date
- Dec 8, 2009
- Last Updated
- Dec 8, 2009
Practice Location
- Address
- HWY 491 N. PINON ST.
- Address 2
- RED MODULAR BLDG
- City
- Shiprock
- State
- New Mexico
- ZIP Code
- 87420-1830
- Phone
- (505) 368-1050
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder) |
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