MEDICARE: BETH ELLEN WILKINSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	696	GA

General Provider Information

NPI Number	:	1184623811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH ELLEN WILKINSON LCSW

Provider Business Mailing Address
First Line	:	60 LAUREL VIEW DR
Second Line	:
City	:	MIDWAY
State	:	GA
Zip	:	31320-3766
Country	:	US
Telephone Number	:	912-884-7367
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 HARMON AVE
Second Line	:	MCUB-DBM-SWA
City	:	FT STEWART
State	:	GA
Zip	:	31314-5604
Country	:	US
Telephone Number	:	912-435-6779
Fax Number	:	912-435-6863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/08/2007

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