Healthcare Provider Details

I. General information

NPI: 1447325824
Provider Name (Legal Business Name): CHRISTIE DELAINE WILSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N. 3RD ST.
OLATHE CO
81425
US

IV. Provider business mailing address

PO BOX 1208
MONTROSE CO
81402
US

V. Phone/Fax

Practice location:
  • Phone: 970-252-4684
  • Fax: 970-323-6117
Mailing address:
  • Phone: 870-252-3200
  • Fax: 970-252-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW- 1131
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: