Provider Demographics
NPI:1164850103
Name:WILKIRSON, RUTH ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:WILKIRSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E. SUNBRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2894
Mailing Address - Country:US
Mailing Address - Phone:479-212-8519
Mailing Address - Fax:479-443-4504
Practice Address - Street 1:65 E. SUNBRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2894
Practice Address - Country:US
Practice Address - Phone:479-212-8519
Practice Address - Fax:479-443-4504
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
AR8755-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker