MEDICARE: RONALD W. WILSON LSCSW

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	002542	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	18030051	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1922170596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD W. WILSON LSCSW

Provider Business Mailing Address
First Line	:	8080 WARD PKWY
Second Line	:	SUITE 315
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2034
Country	:	US
Telephone Number	:	816-931-0011
Fax Number	:	816-531-7740

Provider Business Practice Location Address
First Line	:	8080 WARD PKWY
Second Line	:	SUITE 315
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-2034
Country	:	US
Telephone Number	:	816-931-0011
Fax Number	:	816-531-7740

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/19/2012

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