Provider Demographics
NPI:1053792473
Name:WILKINSON, PATRICIA (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 W WHITE ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3113
Mailing Address - Country:US
Mailing Address - Phone:217-621-6790
Mailing Address - Fax:
Practice Address - Street 1:1503 W WHITE ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-3113
Practice Address - Country:US
Practice Address - Phone:217-621-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.006201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical