Wilson, Jerome

Wilson, Jerome is an sole proprietor health care provider with primary practice located at 100 Diplomat Way , Thibodaux LA 70301-4314. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Family, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Wilson, Jerome can be contacted via phone (985) 316-6483.

Contact Information

Primary practice address
100 Diplomat Way Thibodaux LA 70301-4314
Phone: (985) 316-6483
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Family 103TF0000X 38-3949990 Louisiana
Behavioral Health & Social Service Providers / Family 103TF0000X Louisiana
Behavioral Health & Social Service Providers / Professional 101YP2500X

Profile Details

NPI number 1922648674
LBN Legal business name Wilson, Jerome
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 10th, 2020
Last updated Jan 10th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922648674 NPPES
Louisiana MEDICAID NA

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