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NPI Code Detail

MEDICARE: JENNA E WILSON LCSWA

MEDICARE: JENNA E WILSON LCSWA
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
11041C0700XClinical Social WorkerP007000NC

General Provider Information

NPI Number : 1881932333
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA E WILSON LCSWA
Provider Business Mailing Address
First Line : 730 HAWTHORNE LANE
Second Line : APT 449
City : CHARLOLTTE
State : ND
Zip : 28204
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 360 N CASWELL RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2442
Country : US
Telephone Number : 704-375-0033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2013
Last Update Date : 01/17/2013

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Directions to “ JENNA E WILSON LCSWA” Practice Location

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