Provider Demographics
NPI:1730602178
Name:WILSON, JAMIE DAWN (MS)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:DAWN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:DAWN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3759 BUSINESS 220 STE 101
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-1130
Mailing Address - Country:US
Mailing Address - Phone:814-623-1212
Mailing Address - Fax:
Practice Address - Street 1:3759BUSINESS 220 N, SUITE 101
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522
Practice Address - Country:US
Practice Address - Phone:814-623-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician