MR. JERRY WILSON
NPI 1962731786
Counselor - Addiction (Substance Use Disorder) in Shiprock, NM

Q: What is Jerry Wilson's NPI number?

The NPI number for Jerry Wilson is 1962731786. It was assigned to this individual provider in the NPPES registry on December 8, 2009.

Q: What is Jerry Wilson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

Q: When was this NPI record last updated?

The NPPES record for Jerry Wilson was last updated on December 8, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.

Active since December 08, 2009

HWY 491 N. PINON ST., RED MODULAR BLDG, SHIPROCK, NM 87420(505) 368-1050(505) 368-1055 Get Directions Write a Review

NPPES record last updated: December 8, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Mr. Jerry Wilson NPPES

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

MR. JERRY WILSON (NPI 1962731786) is an individual addiction (substance use disorder) provider in Shiprock, New Mexico, licensed in New Mexico (0122591) and active in the NPI registry since December 2009.

NPPES Registry Identity

NPI1962731786

Entity TypeIndividualMale

Primary Taxonomy101YA0400X

Provider Legal NameMR. JERRY WILSON

Location AddressHWY 491 N. PINON ST., RED MODULAR BLDGShiprock, NM 87420-1830

Mailing AddressPo Box 1830Shiprock, NM 87420-1830 · (505) 368-1050 · Fax (505) 368-1055

Phone(505) 368-1050

Fax(505) 368-1055

Sole ProprietorNo

Enumeration DateDecember 8, 2009

✔ NPI 1962731786 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers

Taxonomy Code101YA0400X

License✔ Licensed in NM · 0122591

HWY 491 N. PINON ST., Shiprock, NM 87420

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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

THERESA J. PAUL LADAC

Counselor (Addiction (Substance Use Disorder))

HWY 491 N. PINON ST.
SHIPROCK, NM 87420

San Juan County (505) 368-1438

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 Jerry Wilson's NPI number?

The NPI number for Jerry Wilson is 1962731786. It was assigned to this individual provider in the NPPES registry on December 8, 2009.

Where is Jerry Wilson located?

Jerry Wilson practices at Hwy 491 N. Pinon St. Red Modular Bldg, Shiprock, NM 87420. The listed phone number is (505) 368-1050.

What is Jerry Wilson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Jerry Wilson was last updated on December 8, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.