Provider Demographics
NPI:1053921965
Name:WILSON-BEA, JAHKALA (BS)
Entity type:Individual
Prefix:MRS
First Name:JAHKALA
Middle Name:
Last Name:WILSON-BEA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:JAHKALA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 S 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3712
Mailing Address - Country:US
Mailing Address - Phone:641-792-0045
Mailing Address - Fax:641-787-0063
Practice Address - Street 1:303 S 2ND AVE W
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3712
Practice Address - Country:US
Practice Address - Phone:641-792-0045
Practice Address - Fax:641-787-0063
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1312101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA60087862Medicaid