| Doctor Name: | THERESA O'BRYAN WILSON |
| NPI Number: | 1821362286 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LISW-S, SAP |
| License Number: | I.1000025-S |
| Business Practice Address: | 11961 Packets St Nw Canal Fulton, OH - 446148453 |
| Business Phone Number: | 3307055086 |
| Business Fax Number: | |
| Mailing Address: | 11961 Packets St Nw, CANAL FULTON |
| State: | OH |
| Postal Code: | 446148453 |
| Phone Number: | 3308545390 |
| Fax Number: | |
| NPI Enumeration Date: | 03/02/2012 |
| NPI Last Update Date: | 05/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I.1000025-S |
| 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 |