MEDICARE: SHARON HEATHER WILHELM

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	SW6919	FL

General Provider Information

NPI Number	:	1861556045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON HEATHER WILHELM

Provider Business Mailing Address
First Line	:	7374 IRONSIDE DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-4466
Country	:	US
Telephone Number	:	904-318-6475
Fax Number	:	904-771-3559

Provider Business Practice Location Address
First Line	:	7374 IRONSIDE DR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-4466
Country	:	US
Telephone Number	:	904-318-6475
Fax Number	:	904-771-3559

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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