Individual
MS. ANGELLUN VANESSA WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3004 KNIGHT ST BLDG 6, SHREVEPORT, LA 71105-2502
(318) 603-6874
Mailing address
4443 PINES RD, SHREVEPORT, LA 71119-8505
(318) 631-3792
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2176
LA
171000000X
Military Health Care Provider
2176
LA
Other
Enumeration date
05/02/2008
Last updated
05/02/2008
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