Individual
GLENNA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
3401 BERRYWOOD DR STE 300, COLUMBIA, MO 65201-6515
(573) 777-8330
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2013015048
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053858050
—
MO
Enumeration date
01/27/2017
Last updated
05/18/2021
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