Provider Demographics
NPI:1255765491
Name:WILSON, VERONICA (MSW)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:MOYNAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 SCHOOL ST APT D
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3451
Mailing Address - Country:US
Mailing Address - Phone:707-391-7140
Mailing Address - Fax:707-468-9860
Practice Address - Street 1:139 FORD ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:707-462-1934
Practice Address - Fax:707-468-9860
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker