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General NPI Number Information
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NPI Number | 1972142008
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Entity Type | Individual
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Provider Name | JANE WILSON LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 10005 24TH ST E
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City | EDGEWOOD
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State | WA
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Zip | 98371-2130
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Country | US
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Telephone | 253-376-7238
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Fax |
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Provider Business Mailing Address
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Address Line | 2779 81ST AVENUE CT E
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City | PUYALLUP
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State | WA
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Zip | 98371-3430
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Country | US
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Telephone | 253-376-7238
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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