Provider Demographics
NPI:1356561781
Name:WILKINSON, TERESA M (LISW)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:712-852-5555
Mailing Address - Fax:
Practice Address - Street 1:3201 1ST STREET
Practice Address - Street 2:
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536-2516
Practice Address - Country:US
Practice Address - Phone:712-852-5555
Practice Address - Fax:712-852-5692
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IALISW 025161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical