Deirdre Wilson, MSW, IC-1758

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

IC-1758 Issued in NV

Practice address

2980 S Rainbow Blvd # 200E
Las Vegas, NV 89146-6531

Phone

(702) 673-7462

NPI assigned

May 14, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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": "1368489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1932545209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "698 S RACETRACK RD UNIT 922",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890158591",
            "telephone_number": "408-386-8955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2980 S RAINBOW BLVD # 200E",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891466531",
            "telephone_number": "702-673-7462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DEIRDRE",
        "credential": "MSW, IC-1758",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-14",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "IC-1758",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "1523P-S",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clementine Wilson
• Courtney Nichole Wilson
• Cozzetta Wilson
• Danielle Wilson
• Debbie Wilson
• Deoshanay Lamyia Wilson, DIPLOMA
• Devon Wilson
• Dezirae Wilson
• Dominic Wilson
• Ekcho Wilson

• Clinical Social Worker in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.