Individual
MS. GRACE BECKER WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LIC SW
Contact information
Practice address
160 BENMONT AVE, BENNINGTON, VT 05201-1873
(802) 379-4548
Mailing address
PO BOX 537, N BENNINGTON, VT 05257-0537
(802) 379-4548
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0890000712
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OVN1867
—
VT
Enumeration date
02/26/2007
Last updated
03/19/2012
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