Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 11006 | MN |
NPI | 1003070970 |
---|---|
Provider Name | Jennifer Wilson |
First Address | Saint Paul, MN 55108-1219 |
Second Address | Saint Paul, MN 55108-1720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 05/05/2009 |