Healthcare Provider Details

I. General information

NPI: 1104150994
Provider Name (Legal Business Name): COURTNEY A WILSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W LINN ST
NORMAN OK
73069-5837
US

IV. Provider business mailing address

215 WEST LINN
NORMAN OK
73069
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-0022
  • Fax: 405-360-4918
Mailing address:
  • Phone: 405-321-0022
  • Fax: 405-360-4918

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: