Individual
JEAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1133 W MILL RD STE 211, EVANSVILLE, IN 47710-3806
(812) 499-0412
Mailing address
1133 W MILL RD STE 211, EVANSVILLE, IN 47710-3806
(812) 499-0412
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
34005035A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34005035A
IN LCSW
IN
Enumeration date
05/23/2008
Last updated
04/09/2013
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