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NPI Code Detail

MEDICARE: MRS. BRIDGETTE MARIE WILSON LICSW, RPT

MEDICARE: MRS. BRIDGETTE MARIE WILSON LICSW, RPT
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 Worker5590CAL

General Provider Information

NPI Number : 1801633565
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRIDGETTE MARIE WILSON LICSW, RPT
Provider Business Mailing Address
First Line : 40 JIM ANGEL DR
Second Line :
City : JACKSONVILLE
State : AL
Zip : 36265-6093
Country : US
Telephone Number : 256-689-6331
Fax Number :
Provider Business Practice Location Address
First Line : 3644 RAINBOW DR
Second Line :
City : RAINBOW CITY
State : AL
Zip : 35906-6313
Country : US
Telephone Number : 256-613-2678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2024
Last Update Date : 01/10/2026

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