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Wanda Wilson, PLLC

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Company Details

Name: Wanda Wilson, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 02 Jan 2019 (7 years ago)
Financial Date End: 31 Jan 2026
Entity Number: 3386233
Place of Formation: IDAHO
File Number: 648766
ZIP code: 83709
County: Ada County
Principal Address: 6615 S ACACIA ST BOISE, ID 83709-6683

Agent

Name Role Address
Wanda Wilson Agent 6615 S ACACIA AVE, BOISE, ID 83709

Manager

Name Role Address Appointed On
Wanda Wilson Manager 6615 S ACACIA ST, BOISE, ID 83709-6683 2025-03-05

National Provider Identifier

NPI Number:
1508670308
Certification Date:
2025-02-03

Authorized Person:

Name:
WANDA WILSON
Role:
THERAPIST
Phone:

Taxonomy:

Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006143982 2025-03-05
Application for Reinstatement 0005783783 2024-07-05
Dissolution/Revocation - Administrative 0003838740 2020-04-08
Initial Filing 0003386233 2019-01-02

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Date of last update: 06 Jul 2025

Sources: Idaho Secretary of State