Healthcare Provider Details

I. General information

NPI: 1316632052
Provider Name (Legal Business Name): MRS. ERIN WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ERIN PARKS

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19910 19 1/2 MILE RD
MARSHALL MI
49068-9332
US

IV. Provider business mailing address

19910 19 1/2 MILE RD
MARSHALL MI
49068-9332
US

V. Phone/Fax

Practice location:
  • Phone: 517-414-5427
  • Fax:
Mailing address:
  • Phone: 517-414-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095787
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: