Provider Demographics
NPI:1538259411
Name:WILKIE, CHRISTY R (LICSW)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:R
Last Name:WILKIE
Suffix:
Gender:F
Credentials:LICSW
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 5007
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5007
Mailing Address - Country:US
Mailing Address - Phone:701-858-0115
Mailing Address - Fax:
Practice Address - Street 1:3314 33RD ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5158
Practice Address - Country:US
Practice Address - Phone:701-237-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND38711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19180Medicaid
ND29129OtherBLUE SHIELD
ND28142OtherBSND
ND74014Medicaid
ND26890OtherBLUE SHIELD OF ND