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General NPI Number Information
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NPI Number | 1396283875
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Entity Type | Individual
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Provider Name | MINDY WILKERSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 19 E MOUNTAIN STREET
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City | FAYETTEVILLE
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State | AR
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Zip | 72701
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Country | US
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Telephone | 479-222-1671
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Fax |
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Provider Business Mailing Address
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Address Line | 22578 OAKVIEW ROAD
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City | SILOAM SPRINGS
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State | AR
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Zip | 72761
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Country | US
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Telephone | 314-922-4558
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150102171
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 149020282
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9034-C
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 9034-C
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License Number State | AR
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