Provider Demographics
NPI:1811496581
Name:WILSON, MEGAN K (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:K
Last Name:WILSON
Suffix:
Gender:
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:3604 JAMESDALE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3560
Practice Address - Country:US
Practice Address - Phone:573-228-9647
Practice Address - Fax:573-777-2410
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2025-04-20
Deactivation Date:2021-02-08
Deactivation Code:
Reactivation Date:2021-04-28
Provider Licenses
StateLicense IDTaxonomies
MO2017028912104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490051579Medicaid