Individual
LORI WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
6610 SE QUAKERVALE RD, RIVERTON, KS 66770-4185
(620) 848-2300
(620) 848-2301
Mailing address
PO BOX 550, RIVERTON, KS 66770-0550
(620) 848-2300
(620) 848-2301
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
4472
KS
1041C0700X
Clinical Social Worker
Primary
3892
KS
Other
Enumeration date
03/13/2007
Last updated
05/17/2012
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