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General NPI Number Information
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NPI Number | 1548812274
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Entity Type | Individual
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Provider Name | KRISTEN NICOLE WILSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 4900 SW 46TH CT APT 211
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City | OCALA
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State | FL
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Zip | 34474-6264
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Country | US
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Telephone | 309-825-8704
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Fax |
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Provider Business Mailing Address
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Address Line | 4900 SW 46TH CT APT 211
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City | OCALA
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State | FL
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Zip | 34474-6264
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Country | US
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Telephone | 309-825-8704
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 2288922
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.016890
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License Number State | IL
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