Provider Demographics
NPI:1427154830
Name:WILBUR, MICHELE L (LISW-S)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:WILBUR
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3519
Mailing Address - Country:US
Mailing Address - Phone:614-636-1227
Mailing Address - Fax:
Practice Address - Street 1:2770 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-3519
Practice Address - Country:US
Practice Address - Phone:614-636-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00092101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWISW24331Medicare ID - Type Unspecified