Provider Demographics
NPI:1275294415
Name:WILSON, SOPHIE MILLBERN
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:MILLBERN
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 HORTON ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1642
Mailing Address - Country:US
Mailing Address - Phone:913-544-9213
Mailing Address - Fax:
Practice Address - Street 1:1201 NW JEFFERSON ST STE D
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-6400
Practice Address - Country:US
Practice Address - Phone:816-427-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional