| Doctor Name: | JESSICA WILSON |
| NPI Number: | 1033506423 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1109 Jones St Kennett, MO - 638573824 |
| Business Phone Number: | 5738886545 |
| Business Fax Number: | |
| Mailing Address: | 1109 Jones St, KENNETT |
| State: | MO |
| Postal Code: | 638573824 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/23/2015 |
| NPI Last Update Date: | 04/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3245S0500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | Substance Abuse Treatment, Children |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. |