MEDICARE: MS. MARCIA WILK 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	1041C0700X	Clinical Social Worker	SW9773	FL

General Provider Information

NPI Number	:	1538489307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA WILK LCSW

Provider Business Mailing Address
First Line	:	301 SKYLINE DR
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-4587
Country	:	US
Telephone Number	:	352-259-6011
Fax Number	:	352-259-6545

Provider Business Practice Location Address
First Line	:	301 SKYLINE DR
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-4587
Country	:	US
Telephone Number	:	352-259-6011
Fax Number	:	352-259-6545

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

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	06/03/2010

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