Doctor Name: | PAULA JEAN WISDOM |
NPI Number: | 1689895286 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | 003051 |
Business Practice Address: | 11667 Jinkerson Rd Potosi, MO - 636643012 |
Business Phone Number: | 5734364809 |
Business Fax Number: | |
Mailing Address: | 11667 Jinkerson Rd, POTOSI |
State: | MO |
Postal Code: | 636643012 |
Phone Number: | 5734364809 |
Fax Number: | |
NPI Enumeration Date: | 05/01/2007 |
NPI Last Update Date: | 01/05/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 003051 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |