Individual
LISA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6333 ODANA RD, WISCONSIN PSYCHOTHERAPY AND HEALING CENTER, MADISON, WI 53719-1107
(608) 288-8022
Mailing address
6333 ODANA RD, WISCONSIN PSYCHOTHERAPY AND HEALING CENTER, MADISON, WI 53719-1107
(608) 288-8022
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3896123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40932100
—
WI
Enumeration date
09/20/2006
Last updated
07/08/2007
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