Provider Demographics
NPI:1811048200
Name:WILSON, EMILY B (LISW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:B
Last Name:WILSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:B
Other - Last Name:ROCKENFELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:4240 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6612
Mailing Address - Country:US
Mailing Address - Phone:513-891-0650
Mailing Address - Fax:513-891-2838
Practice Address - Street 1:1080 NIMITZVIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4314
Practice Address - Country:US
Practice Address - Phone:513-688-7555
Practice Address - Fax:513-688-0591
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0009830104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311705723OtherEIN