Provider Demographics
NPI:1740843259
Name:WILBUR, VERONICA LEE (LISW)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:LEE
Last Name:WILBUR
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 RIDGEDALE DR E
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3217
Mailing Address - Country:US
Mailing Address - Phone:614-467-0724
Mailing Address - Fax:
Practice Address - Street 1:1159 RIDGEDALE DR E
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3217
Practice Address - Country:US
Practice Address - Phone:614-467-0724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22034541041C0700X
OHS.18022101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical