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NPI Code Detail

MEDICARE: EVA JEAN WILSON

MEDICARE: EVA JEAN WILSON
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1265954234
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVA JEAN WILSON
Provider Business Mailing Address
First Line : 3100 E 45TH ST STE 212
Second Line :
City : CLEVELAND
State : OH
Zip : 44127-1093
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3100 E 45TH ST STE 212
Second Line :
City : CLEVELAND
State : OH
Zip : 44127-1093
Country : US
Telephone Number : 216-341-5510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2017
Last Update Date : 07/12/2017

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Directions to “ EVA JEAN WILSON ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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