VICTORIA L WILSON


Address: 680 3 Mile Rd Nw, Suite C, Grand Rapids, MI 49544-8218
Phone: 6166473460

VICTORIA L WILSON (NPI# 1649208018) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1649208018
Entity Type Individual
Full Name VICTORIA L WILSON
Credential MA, LLP, BCBA
Practice Address 680 3 Mile Rd Nw
Suite C
Grand Rapids
MI 49544-8218
Practice Telephone 6166473460
Practice Fax Number 6166473467
Mailing Telephone 6166473460
Mailing Fax Number 6166473467
Enumeration Date 2006-06-28
Last Update Date 2015-04-22
NPI Deactivation Date 02/13/2007
NPI Reactivation Date 2008-02-26
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TB0200X Psychologist
Specialization: Cognitive & Behavioral
6301012332 MI Behavioral Health & Social Service Providers
N 103K00000X Behavioral Analyst 1-14-15288 MI Behavioral Health & Social Service Providers

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Office Location

Street Address 680 3 MILE RD NW
SUITE C
City GRAND RAPIDS
State MI
Zip Code 49544-8218

Providers in the same location

NPI Name Taxonomy Address Enumeration
1235116872 Alpine Family Podiatry PC Podiatrist 680 3 Mile Rd Nw, Grand Rapids, MI 49544-8218 2005-12-24
1265974976 Kimberly Sue Lichon-tufer Social Worker 680 3 Mile Rd Nw, Suite C, Grand Rapids, MI 49544-8218 2016-11-11
1992154769 Northpointe Family Dental Dentist 680 3 Mile Rd Nw, Grand Rapids, MI 49544-8218 2016-06-12
1386017499 Stephanie Exton Behavioral Analyst 680 3 Mile Rd Nw, Suite C, Grand Rapids, MI 49544-8218 2015-11-11
1669884169 Jennifer Barabas Social Worker 680 3 Mile Rd Nw, Suite C, Grand Rapids, MI 49544-8218 2014-06-02
1407103047 Susan F. Jongekryg Social Worker 680 3 Mile Rd Nw, Suite C, Grand Rapids, MI 49544-8218 2012-08-14
1427288000 Carrie Louise Labarge Psychologist 680 3 Mile Rd Nw, Suite C, Grand Rapids, MI 49544-8218 2009-07-17
1033398581 Sandra Jean Wynn-stelt Psychologist 680 3 Mile Rd Nw, Suite C, Grand Rapids, MI 49544-8218 2007-11-01
1366594897 Laura Velzen Triezenberg Social Worker 680 3 Mile Rd Nw, Suite C, Grand Rapids, MI 49544-8218 2007-01-17
1154308724 Michael G Meyers Podiatrist 680 3 Mile Rd Nw, Grand Rapids, MI 49544-8218 2005-12-27
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1437764511 Titiana Shanee Richardson Social Worker 113 Lake Michigan Drive Northwest, Grand Rapids, MI 49544 2020-09-15
1699317792 Leah Grace Nesburg Speech-Language Pathologist 600 3 Mile Road Nw, Suite 102, Walker, MI 49544 2019-10-10
1316467954 Hendrik Vanholsbeeck Dentist 2515 Alpine Ave Nw # A, Grand Rapids, MI 49544 2017-06-25
1467988584 Leah Feenstra Behavior Technician 668 3 Mile Nw, Grand Rapids, MI 49544 2017-05-10
1760920698 Heidi Catherine Stultz-griffey Pharmacist 970 4 Mile Rd Nw Apt 1d, Grand Rapids, MI 49544 2017-02-12
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1255789145 Lucas David Kelley Technician, Other 668 3 Mile Ave Nw, Suite 2, Grand Rapids, MI 49544 2016-06-01
1144611666 Stephen Kornoely Social Worker 2118 3 Mile Road Nw, Grand Rapids, MI 49544 2015-02-06
1023368305 Brian William Rogers Registered Nurse 712 North Center Dr. Nw, Grand Rapids, MI 49544 2012-09-14
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Taxonomy Information

Taxonomy Code 103TB0200X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Cognitive & Behavioral

Taxonomy Definition

Definition to come...
Notes: [1/1/2007: title modified]

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1427288000 Carrie Louise Labarge Psychologist 680 3 Mile Rd Nw, Suite C, Grand Rapids, MI 49544-8218 2009-07-17
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1033398581 Sandra Jean Wynn-stelt Psychologist 680 3 Mile Rd Nw, Suite C, Grand Rapids, MI 49544-8218 2007-11-01
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Competitor

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City GRAND RAPIDS
Zip Code 49544

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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