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NPI Code Detail

MEDICARE: KASSANDRA ELIZABETH WILSON

MEDICARE: KASSANDRA ELIZABETH 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 Worker135140-121WI

General Provider Information

NPI Number : 1417804584
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASSANDRA ELIZABETH WILSON
Provider Business Mailing Address
First Line : 540 E GRAND AVE
Second Line :
City : BELOIT
State : WI
Zip : 53511-6314
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 540 E GRAND AVE
Second Line :
City : BELOIT
State : WI
Zip : 53511-6314
Country : US
Telephone Number : 608-289-1505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2026
Last Update Date : 03/16/2026

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Directions to “ KASSANDRA ELIZABETH WILSON ” Practice Location

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