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NPI Code Detail

MEDICARE: LAUREL ANN WILSON LCSW

MEDICARE: LAUREL ANN 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
11041C0700XClinical Social WorkerLCSW-25275ID

General Provider Information

NPI Number : 1982629291
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREL ANN WILSON LCSW
Provider Business Mailing Address
First Line : 2527 AGATE ST
Second Line :
City : EUGENE
State : OR
Zip : 97403-1684
Country : US
Telephone Number : 541-505-7436
Fax Number :
Provider Business Practice Location Address
First Line : 100 RIVER AVE
Second Line :
City : EUGENE
State : OR
Zip : 97404-2507
Country : US
Telephone Number : 541-607-7547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 07/08/2007

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Directions to “ LAUREL ANN WILSON LCSW” Practice Location

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