Provider Demographics
NPI:1518619139
Name:WILKINSON, LANIE JEAN (MA, LPCC, RD)
Entity type:Individual
Prefix:
First Name:LANIE
Middle Name:JEAN
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MA, LPCC, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28854 WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8425
Mailing Address - Country:US
Mailing Address - Phone:303-817-6884
Mailing Address - Fax:
Practice Address - Street 1:28854 WESTERN DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-8425
Practice Address - Country:US
Practice Address - Phone:303-817-6884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86102663133V00000X
COLPCC.0020669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered