Provider Demographics
NPI:1114385572
Name:WILSON, EMILIE CLASGENS (ND)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:CLASGENS
Last Name:WILSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1164
Mailing Address - Country:US
Mailing Address - Phone:928-227-1899
Mailing Address - Fax:800-536-1048
Practice Address - Street 1:1590 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-227-1899
Practice Address - Fax:800-536-1048
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-001105171100000X
WAAC60632587171100000X
WANT60609291175F00000X
AZ17-1630175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist