Provider Demographics
NPI:1306269782
Name:DRETKE-WILSON, LAURIE (MSW, ISW7752)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:DRETKE-WILSON
Suffix:
Gender:F
Credentials:MSW, ISW7752
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2185
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33045-2185
Mailing Address - Country:US
Mailing Address - Phone:509-218-6559
Mailing Address - Fax:305-292-6723
Practice Address - Street 1:1205 4TH ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3707
Practice Address - Country:US
Practice Address - Phone:305-879-4133
Practice Address - Fax:305-292-6723
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health