Individual
MS. JANE WILMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1601 E 28TH ST, TRENTON, MO 64683-1178
(660) 359-4487
Mailing address
PO BOX 30, TRENTON, MO 64683-0030
(660) 359-4487
(660) 359-2958
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2003029038
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33758018
BCBS PROVIDER NUMBER
MO
05
—
495358202
—
MO
05
—
495358210
—
MO
Enumeration date
07/09/2006
Last updated
12/18/2020
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