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General NPI Number Information
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NPI Number | 1841771144
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Entity Type | Individual
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Provider Name | JERI ELLEN WILSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 8885 RIO SAN DIEGO DR STE 237
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City | SAN DIEGO
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State | CA
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Zip | 92108-1661
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Country | US
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Telephone | 619-922-1815
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 710733
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City | SANTEE
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State | CA
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Zip | 92072-0733
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Country | US
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Telephone | 619-436-1343
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Fax | 619-764-4020
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW74608
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License Number State | CA
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