Provider Demographics
NPI:1639111834
Name:WILSON, DENISE C (EDS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:C
Last Name:WILSON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 LAKESIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 E ALCOTT AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2903
Practice Address - Country:US
Practice Address - Phone:218-736-6987
Practice Address - Fax:218-736-6980
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0790103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN116408OtherUCARE MINNESOTA
MNHP23065OtherHEALTHPARTNERS
MN1010725OtherPREFERREDONE
MN62-20515OtherUNITED BEHAVIORAL HEALTH
MN8L660WIOtherBLUE SHIELD OF MINNESOTA