Healthcare Provider Details

I. General information

NPI: 1831382613
Provider Name (Legal Business Name): ABRAM DILLON WILKS PLCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 LOUISE CIR
COLUMBIA MO
65201-3892
US

IV. Provider business mailing address

4304 S BEARFIELD RD
COLUMBIA MO
65201-9557
US

V. Phone/Fax

Practice location:
  • Phone: 573-442-3429
  • Fax:
Mailing address:
  • Phone: 573-874-8686
  • Fax: 573-874-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2007025105
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: