Active NPI
Janice Susan Wilson, LISW
- Social Worker
- Roswell, NM
National Provider Identifier
1700970431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- I-05660
- Practice address
- 300 W 2ND St
Roswell, NM 88201-4600 - Phone
- (505) 624-2661
- Fax
- (505) 625-0643
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | I-05660 | NM | Primary |
Addresses
Primary practice location
300 W 2ND St
Roswell, NM 88201-4600
Mailing address
PO Box 2870
Roswell, NM 88202-2870
Phone (505) 624-2661
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17104815 | Medicaid | NM |
Other names 1
- Mrs. J. Susan Wilson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I-05660 | NM | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1700970431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2870",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882022870",
"telephone_number": "505-624-2661",
"fax_number": "505-625-0643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W 2ND ST",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882014600",
"telephone_number": "505-624-2661",
"fax_number": "505-625-0643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JANICE",
"middle_name": "SUSAN",
"name_prefix": "Mrs.",
"credential": "LISW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NM",
"license": "I-05660",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "17104815",
"state": "NM"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "J.",
"last_name": "WILSON",
"middle_name": "SUSAN",
"prefix": "MRS.",
"credential": "LISW",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.