Brodie M Wilson, LMSW
Individual provider Active NPI Social Worker · Ellsworth Afb, SD
NPI 1710658976 · NPPES record last updated Sep 25, 2023
Key facts
- NPI
- 1710658976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 103451 (TX)
- Practice address
- 2900 Doolittle Dr
Ellsworth Afb, SD 57706-4821 - Phone
- (605) 385-3656
- NPI assigned
- Sep 27, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103451 | TX | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 103451 | TX | Yes |
Addresses
Primary practice location
2900 Doolittle Dr
Ellsworth Afb, SD 57706-4821
Mailing address
2900 Doolittle Dr
Ellsworth Afb, SD 57706-4821
Phone (605) 385-3656
Other providers in Ellsworth Afb, SD
- Christle Celeste Usera
- Michael J Vadovsky
- Ivan Vicente
- John Tyler Vogel
- Kayla Lynn Wede
- Gavin Yseth
- Michelle Andaya Ziegler
- Sarah Zimmerman
- Anthony Zunker
All providers in Ellsworth Afb, SD · Social Worker in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.