Individual
ALISSE LINLEY WILBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1525 N RITTER AVE, STE 500, INDIANAPOLIS, IN 46219-3026
(317) 359-5467
(317) 322-4095
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
33006143A
IN
1041C0700X
Clinical Social Worker
Primary
34006861A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201192980A
—
IN
Enumeration date
10/27/2011
Last updated
01/28/2015
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