Provider Demographics
NPI:1104603034
Name:WILSON, SUNNY JO (MSW, CAPSW)
Entity type:Individual
Prefix:MRS
First Name:SUNNY
Middle Name:JO
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW, CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 WYLIE ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-3559
Mailing Address - Country:US
Mailing Address - Phone:218-260-9575
Mailing Address - Fax:
Practice Address - Street 1:700 HALE ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-2787
Practice Address - Country:US
Practice Address - Phone:715-424-4682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130437-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker