Individual
KIMBERLY R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1312 WESTEN ST, BOWLING GREEN, KY 42104-3352
(270) 904-1072
(270) 904-1073
Mailing address
1312 WESTEN ST, BOWLING GREEN, KY 42104-3352
(270) 904-1072
(270) 904-1073
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
KY-4967
KY
1041C0700X
Clinical Social Worker
Primary
KY 3505
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100269010
—
KY
Enumeration date
03/11/2011
Last updated
01/14/2019
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