Provider Demographics
NPI:1073297149
Name:WILSON, ROSEMARIE NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARIE
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:NICOLE
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4101 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5029
Mailing Address - Country:US
Mailing Address - Phone:913-682-2000
Mailing Address - Fax:913-946-1519
Practice Address - Street 1:4101 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5014
Practice Address - Country:US
Practice Address - Phone:913-682-2000
Practice Address - Fax:913-946-1519
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12470-T104100000X
NCP014247104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker