Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dominique Wilson

Individual provider Professional Counselor · NPI 1083369490

Dominique Wilson is a Mental Health Counselor in Chisago City, Minnesota. Qualified in 2010, 16 years ago. Practices with Fairview Express Care, a 1,964-clinician group, accepts Medicare assignment and offers telehealth.

Years since qualifying
16
In the registry since
2022

Practice location Address checks out

11185 Lake Blvd Ste 205
Chisago City, MN 55013-9814
Phone: (952) 228-3487
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X

Record details

NPI number1083369490
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedFebruary 14, 2022
Last updated in NPPESFebruary 14, 2022
Certification dateFebruary 14, 2022
Mailing address17566 Xingu St Ne, Columbus, MN 55025-8869

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Fairview Express Care — 1964 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Chisago City