Healthcare Provider Details

I. General information

NPI: 1669075222
Provider Name (Legal Business Name): MEGANN WILKERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 03/18/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 CURLEW DR
AMMON ID
83406-4718
US

IV. Provider business mailing address

3695 E 20 N
RIGBY ID
83442-5475
US

V. Phone/Fax

Practice location:
  • Phone: 208-523-5319
  • Fax: 208-523-5627
Mailing address:
  • Phone: 208-351-6397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: