| Doctor Name: | MISS GRETCHEN WILSON |
| NPI Number: | 1063477321 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CSW |
| License Number: | 5363133-3502 |
| Business Practice Address: | 1578 W 1700 S #200 Slc, UT - 841043470 |
| Business Phone Number: | 8019722711 |
| Business Fax Number: | 8019722709 |
| Mailing Address: | 875 Donner Way, #209 SLC |
| State: | UT |
| Postal Code: | 841082159 |
| Phone Number: | 8019722711 |
| Fax Number: | 8019722709 |
| NPI Enumeration Date: | 04/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 5363133-3502 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |