MEDICARE: WENDY WILSON-HARGROVE LCSW

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	3048	KY

General Provider Information

NPI Number	:	1457434391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY WILSON-HARGROVE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 614
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42241-0614
Country	:	US
Telephone Number	:	270-886-2205
Fax Number	:	270-886-0392

Provider Business Practice Location Address
First Line	:	735 NORTH DR
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-2620
Country	:	US
Telephone Number	:	270-886-5163
Fax Number	:	270-886-5178

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	01/26/2017

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