MEDICARE: MRS. SHEREE COLE WILSON 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	LCSW-4520	HI

General Provider Information

NPI Number	:	1851915722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHEREE COLE WILSON LCSW

Provider Business Mailing Address
First Line	:	6851 B 112TH STREET
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706
Country	:	US
Telephone Number	:	808-354-8071
Fax Number	:

Provider Business Practice Location Address
First Line	:	6851 B 112TH STREET
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706
Country	:	US
Telephone Number	:	808-354-8071
Fax Number	:

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

Provider Enumeration Date	:	06/05/2020
Last Update Date	:	06/05/2020

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