Provider Demographics
NPI:1639443807
Name:WILKERSON, NANCY A (LSCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 W 75TH ST STE 200-24
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2209
Mailing Address - Country:US
Mailing Address - Phone:913-205-8766
Mailing Address - Fax:913-262-0405
Practice Address - Street 1:10000 W 75TH ST STE 200-24
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2209
Practice Address - Country:US
Practice Address - Phone:913-205-8766
Practice Address - Fax:913-262-0405
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical