Provider Demographics
NPI:1427692623
Name:WILSON, ROXANNE FRANKLIN (BA, QMHA, PSS)
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:FRANKLIN
Last Name:WILSON
Suffix:
Gender:F
Credentials:BA, QMHA, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NE 2ND ST UNIT 133
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4762
Mailing Address - Country:US
Mailing Address - Phone:503-472-4511
Mailing Address - Fax:503-714-6306
Practice Address - Street 1:1900 NE HIGHWAY 99W STE K
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2757
Practice Address - Country:US
Practice Address - Phone:503-472-4511
Practice Address - Fax:503-714-6306
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW2008175T00000X, 171M00000X
133NN1002X, 174H00000X, 172A00000X, 1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No172A00000XOther Service ProvidersDriver
No1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW2008OtherOHA THW REGISTRY NUMBER