Individual
CARLY RENAE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW CSW PIP
Contact information
Practice address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
(605) 347-2511
Mailing address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
(605) 347-2511
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2168
SD
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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