NPI 1013334622
Ebony Wilson
Practice location
- Address
- 3514 Blair Ave, Saint Louis, MO 63107-3717
- Phone
- (314) 216-0088
- Mailing address
- PO Box 24754, Saint Louis, MO 63115-0654
Registered specialties
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
Registry record
- NPI
- 1013334622
- Entity type
- Individual
- Sex (as registered)
- Female
- NPI issued
- 20 Mar 2014
- Record last updated
- 20 Mar 2014
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.