Wilson, Stacy Michelle

Wilson, Stacy Michelle is an individual health care provider with primary practice located at 2003 Se Walton Blvd , Bentonville AR 72712-3725. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Wilson, Stacy Michelle can be contacted via phone (479) 464-8081.

Contact Information

Primary practice address
2003 Se Walton Blvd Bentonville AR 72712-3725
Phone: (479) 464-8081
Fax: (479) 464-0674
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 2075-C Arkansas

Profile Details

NPI number 1356464556
LBN Legal business name Wilson, Stacy Michelle
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356464556 NPPES
Arkansas Other 5A368 BLUE CROSS
Arkansas Other 07050035400 BLUE CROSS

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