Provider Demographics
NPI:1548959125
Name:WILSON, GINGER JADE I
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:JADE
Last Name:WILSON
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 TOWNSHIP ROAD 199
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-8721
Mailing Address - Country:US
Mailing Address - Phone:740-533-7218
Mailing Address - Fax:
Practice Address - Street 1:1043 TOWNSHIP ROAD 199
Practice Address - Street 2:
Practice Address - City:PEDRO
Practice Address - State:OH
Practice Address - Zip Code:45659-8721
Practice Address - Country:US
Practice Address - Phone:740-533-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator