Provider Demographics
NPI:1518533009
Name:WILCOX, JENNIE A (LLMSW)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:A
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 S WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-5017
Mailing Address - Country:US
Mailing Address - Phone:760-672-0604
Mailing Address - Fax:
Practice Address - Street 1:1332 S WILSON AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-5017
Practice Address - Country:US
Practice Address - Phone:760-672-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011099261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical