Individual
TINA WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
310 W UNION ST, BOISE, ID 83702-4450
(208) 830-8655
Mailing address
310 W UNION ST, BOISE, ID 83702-4450
(208) 830-8655
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
28014
ID
1041C0700X
Clinical Social Worker
LCSW-28014
ID
Other
Enumeration date
08/30/2013
Last updated
02/21/2024
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