Provider Demographics
NPI:1023173911
Name:WILSON, JENNIFER LYNN (MA, LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:WILSON DIEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 210095
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0095
Mailing Address - Country:US
Mailing Address - Phone:520-621-3334
Mailing Address - Fax:520-626-6105
Practice Address - Street 1:1224 E LOWELL ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0095
Practice Address - Country:US
Practice Address - Phone:520-621-3334
Practice Address - Fax:520-626-3105
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10115101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health