Theresa Ann Wilson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0698081 Issued in NY

Practice address

Milepost 388 Highway 264
Polacca, AZ 86042-4000

Phone

(928) 737-6188

Fax

(928) 737-6098

NPI assigned

Jul 12, 2013

Last updated

Jul 12, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hopi Health Care Center

  • Clinical Social Worker
  • Polacca, AZ
  • NPI 1891130522
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373587200000",
    "number": "1295176733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4000",
            "city": "POLACCA",
            "state": "AZ",
            "postal_code": "860424000",
            "telephone_number": "928-737-6188",
            "fax_number": "928-737-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MILEPOST 388 HIGHWAY 264",
            "city": "POLACCA",
            "state": "AZ",
            "postal_code": "860424000",
            "telephone_number": "928-737-6188",
            "fax_number": "928-737-6098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "THERESA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-12",
        "last_updated": "2013-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "0698081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Anne Vitz, P.T.
• Claudia Gail Von Hendricks, DDS
• Diane Renee Weidley, RDH
• Ruth Ana Williams, RDH
• Gary Alan Wilson, DDS
• Biau Wong, PHARMD
• Jessica Wright

• Clinical Social Worker in Polacca, AZ
• Providers in Polacca, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.