Provider Demographics
NPI:1922724954
Name:GOSSELIN, WESLEY (MSSW)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:GOSSELIN
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FOREST CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5079
Mailing Address - Country:US
Mailing Address - Phone:865-278-8711
Mailing Address - Fax:
Practice Address - Street 1:100 FOREST CT
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5079
Practice Address - Country:US
Practice Address - Phone:865-278-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12974104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker