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EBONY WILSON
NPI 1013334622
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Saint Louis, MO

Active since March 20, 2014
3514 BLAIR AVE, SAINT LOUIS, MO 63107(314) 216-0088 Get Directions Write a Review

NPPES record last updated: March 20, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Ebony Wilson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EBONY WILSON (NPI 1013334622) is an individual community based residential treatment facility, intellectual and/or developmental disabilities provider in Saint Louis, Missouri and active in the NPI registry since March 2014.

NPPES Registry Identity

NPI1013334622
Entity TypeIndividualFemale
Primary Taxonomy320900000X
Provider Legal NameEBONY WILSON
Location Address3514 BLAIR AVESaint Louis, MO 63107-3717
Mailing AddressPo Box 24754Saint Louis, MO 63115-0654 · (314) 216-0088
Phone(314) 216-0088
Sole ProprietorYes
Enumeration DateMarch 20, 2014
✔ NPI 1013334622 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320900000X
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
3514 BLAIR AVE, Saint Louis, MO 63107
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebony Wilson's NPI number?

The NPI number for Ebony Wilson is 1013334622. It was assigned to this individual provider in the NPPES registry on March 20, 2014.

Where is Ebony Wilson located?

Ebony Wilson practices at 3514 Blair Ave, Saint Louis, MO 63107. The listed phone number is (314) 216-0088.

What is Ebony Wilson's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

When was this NPI record last updated?

The NPPES record for Ebony Wilson was last updated on March 20, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.