Individual
JAQULYN LEE LUCILLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3354 HIGHWAY 160, INDEPENDENCE, KS 67301-7841
(620) 331-1748
Mailing address
PO BOX 688, INDEPENDENCE, KS 67301-0688
(620) 331-1748
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
PENDING
KS
Other
Enumeration date
06/17/2024
Last updated
06/17/2024
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