Provider Demographics
NPI:1245645688
Name:WILCOX, DE ELLA DAWN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:DE ELLA
Middle Name:DAWN
Last Name:WILCOX
Suffix:
Gender:
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7430
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-7430
Mailing Address - Country:US
Mailing Address - Phone:320-460-2550
Mailing Address - Fax:320-217-5453
Practice Address - Street 1:2233 ROOSEVELT RD. STE. 1
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301
Practice Address - Country:US
Practice Address - Phone:320-460-2550
Practice Address - Fax:320-217-5453
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN232851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical