Carla Sachiko Wilson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

24832 Issued in MN

Practice address

5555 Boone Ave N
New Hope, MN 55428-3636

Phone

(763) 504-8821

NPI assigned

May 9, 2019

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1557360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565654400000",
    "number": "1528623022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 19TH AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554184726",
            "telephone_number": "612-385-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 BOONE AVE N",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283636",
            "telephone_number": "763-504-8821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CARLA",
        "middle_name": "SACHIKO",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-09",
        "last_updated": "2019-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "24832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward Wesley Whittaker, LADC
• Doris K Whymark
• Jay Alan Wilcox, DDS
• Jessica Irene Wille, PTA
• Hannah Lea Williamson, MS CCC-SLP
• Lucy Marie Wilson, MA OTR/L
• Kathleen Marie Wise, M.A., L.P.
• Jafar Yakubu, NP
• Paige Friedman Young
• Your Dental

• Clinical Social Worker in New Hope, MN
• Providers in New Hope, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; 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.