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General NPI Number Information
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NPI Number | 1689356669
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Entity Type | Individual
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Provider Name | KIMBERLY DAWN WILSON LPC
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Gender | Female
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 102 4TH ST
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City | HILLSBORO
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State | MO
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Zip | 63050-5043
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Country | US
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Telephone | 161-887-7442
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 MARTIN LUTHER KING DR
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City | BLOOMINGTON
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State | IL
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Zip | 61701-1429
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Country | US
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Telephone | 888-924-3786
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2023030910
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2025026687
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License Number State | MO
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