Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 992139 | CO |
NPI | 1003028481 |
---|---|
Provider Name | Christine Lynn Wilcox |
First Address | Manitou Springs, CO 80829-2305 |
Second Address | Manitou Springs, CO 80829-2305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2007 |
Last Update Date | 28/08/2007 |