Provider Demographics
NPI:1225121171
Name:WILCOCK, ELLEN BILANOW (LICSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:BILANOW
Last Name:WILCOCK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 YORK AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1868
Mailing Address - Country:US
Mailing Address - Phone:612-920-0243
Mailing Address - Fax:612-922-9428
Practice Address - Street 1:3507 W 50TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2124
Practice Address - Country:US
Practice Address - Phone:612-920-0243
Practice Address - Fax:612-922-9428
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical