Individual
MS. HEATHER DAWN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
200 HIGHWAY 2 W, DEVILS LAKE, ND 58301-3532
(709) 166-5220
(701) 665-2300
Mailing address
PO BOX 650, DEVILS LAKE, ND 58301-0650
(701) 665-2200
(701) 665-2300
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3819
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054518
—
ND
01
—
27582
BCBS PIN
ND
Enumeration date
09/22/2006
Last updated
04/15/2011
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