Provider Demographics
NPI:1104693159
Name:WILKERSON, PATRICIA J (MSW, LSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 N COUNTY LINE RD E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-9637
Mailing Address - Country:US
Mailing Address - Phone:765-414-8205
Mailing Address - Fax:
Practice Address - Street 1:706 N COUNTY LINE RD E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-9637
Practice Address - Country:US
Practice Address - Phone:765-414-8205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011226A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health