Individual
LAURA KS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
360 E 10TH AVE STE 400, EUGENE, OR 97401-3273
(541) 687-6983
Mailing address
360 E 10TH AVE STE 400, EUGENE, OR 97401-3273
(541) 687-6983
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L5438
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R167058
MEDICARE PTAN
—
Enumeration date
12/15/2010
Last updated
03/02/2023
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