| Doctor Name: | MR. JOHN ROOSEVELT WILSON |
| NPI Number: | 1093955775 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LISW |
| License Number: | I0600163 |
| Business Practice Address: | 1955 Ohio Dr Grove City, OH - 431234835 |
| Business Phone Number: | 6142575800 |
| Business Fax Number: | 6142575801 |
| Mailing Address: | 339 Wind Rush Ave, COLUMBUS |
| State: | OH |
| Postal Code: | 432134439 |
| Phone Number: | 6149868911 |
| Fax Number: | |
| NPI Enumeration Date: | 02/20/2009 |
| NPI Last Update Date: | 02/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I0600163 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |