Individual
SUSAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
360 KEEN STREET, BURKESVILLE, KY 42717-1080
(270) 864-1472
(270) 864-1693
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 864-1472
(270) 864-1693
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1830
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100017280
—
KY
Enumeration date
07/14/2006
Last updated
05/05/2014
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