Provider Demographics
NPI:1710421995
Name:WILSON, PAULA (BA, RBT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5977
Mailing Address - Country:US
Mailing Address - Phone:989-401-9020
Mailing Address - Fax:
Practice Address - Street 1:300 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5977
Practice Address - Country:US
Practice Address - Phone:989-401-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician