Healthcare Provider Details

I. General information

NPI: 1538674791
Provider Name (Legal Business Name): WILLIAM WILKERSON LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 01/08/2024
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SYCAMORE ST
CINCINNATI OH
45202-1305
US

IV. Provider business mailing address

311 ALBERT SABIN WAY
CINCINNATI OH
45229-2838
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-6697
  • Fax:
Mailing address:
  • Phone: 513-558-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2208486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: