Ebony Wilson

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Practice address

3514 Blair Ave
Saint Louis, MO 63107-3717

Phone

(314) 216-0088

NPI assigned

Mar 20, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395273600000",
    "number": "1013334622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24754",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631150654",
            "telephone_number": "314-216-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3514 BLAIR AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631073717",
            "telephone_number": "314-216-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "EBONY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-20",
        "last_updated": "2014-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Wilson
• Danika Wilson, OTR/L
• David B Wilson, MD
• Deann Wilson, PNP-BC
• Denise Lyvette Wilson, LCSW
• Harlan Joseph Wilson, D.D.S.
• Jane Lewis Wilson, OTR/L
• Jedediah Heath Wilson, MED, LPC, NCC
• Jeffrey S Wilson, RPH
• Jenna Leigh Wilson, MD

• All providers in Saint Louis, MO
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.