| Doctor Name: | MRS. DIANNE MARIE WILSON |
| NPI Number: | 1255495628 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BHU-HS |
| License Number: | |
| Business Practice Address: | 17160 130th Ave Nunica, MI - 494489450 |
| Business Phone Number: | 6168474460 |
| Business Fax Number: | 6168474467 |
| Mailing Address: | 2350 Filonow Dr, MUSKEGON |
| State: | MI |
| Postal Code: | 494444070 |
| Phone Number: | 2317678440 |
| Fax Number: | 6168474467 |
| NPI Enumeration Date: | 12/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |