Individual
MRS. JANICE SUSAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
300 W 2ND ST, ROSWELL, NM 88201-4600
(505) 624-2661
(505) 625-0643
Mailing address
PO BOX 2870, ROSWELL, NM 88202-2870
(505) 624-2661
(505) 625-0643
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I-05660
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17104815
—
NM
Enumeration date
10/03/2006
Last updated
07/09/2007
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