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NPI Code Detail

MEDICARE: MS. CHE WILSON LMSW

MEDICARE: MS. CHE 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
1104100000XSocial Worker2023035505MO

General Provider Information

NPI Number : 1659159671
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHE WILSON LMSW
Provider Business Mailing Address
First Line : 827 SOUTHWEST BLVD APT A
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-2647
Country : US
Telephone Number : 573-301-6026
Fax Number :
Provider Business Practice Location Address
First Line : 2701 W EDGEWOOD DR STE 101
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-5890
Country : US
Telephone Number : 573-681-3249
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2023
Last Update Date : 09/20/2023

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Directions to “ MS. CHE WILSON LMSW” Practice Location

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