Mallory Antonetta Wilson, SUDA
Mallory Antonetta Wilson, SUDA is an Addiction (Substance Use Disorder) Counselor in Twin Falls, Idaho. Licensed in Idaho. Registered with an NPI since 2024.
- Licensed in
- ID
- In the registry since
- 2024
Practice location Address checks out
630 Addison Ave W Ste 1000Twin Falls, ID 83301-5853
Phone: (208) 736-5048
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Specialties & licences
| Addiction (Substance Use Disorder) Counselor (primary) | Taxonomy 101YA0400X · Licence 13044 (ID) |
|---|
Record details
| NPI number | 1730923699 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Credentials | SUDA |
| Sole proprietor | No |
| NPI enumerated | June 24, 2024 |
| Last updated in NPPES | June 24, 2024 |
| Certification date | June 24, 2024 |
| Mailing address | 630 Addison Ave W Ste 1000, Twin Falls, ID 83301-5853 |
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