MEDICARE: ERIN ELIZABETH WILSON LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	7649	KS

General Provider Information

NPI Number	:	1245509868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN ELIZABETH WILSON LMSW

Provider Business Mailing Address
First Line	:	3130 SW MUNSON AVE
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66604-1631
Country	:	US
Telephone Number	:	785-271-6657
Fax Number	:	785-271-6572

Provider Business Practice Location Address
First Line	:	3130 SW MUNSON AVE
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66604-1631
Country	:	US
Telephone Number	:	785-271-6657
Fax Number	:	785-271-6572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	12/28/2011

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