Provider Demographics
NPI:1447686811
Name:WILKINSON, JOELEEN JOYCE (LICSW, CDP, MAC)
Entity type:Individual
Prefix:MRS
First Name:JOELEEN
Middle Name:JOYCE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:LICSW, CDP, MAC
Other - Prefix:
Other - First Name:JOELEEN
Other - Middle Name:JOYCE
Other - Last Name:SCHNETTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2929 W 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5507
Mailing Address - Country:US
Mailing Address - Phone:509-768-6852
Mailing Address - Fax:
Practice Address - Street 1:1405 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3527
Practice Address - Country:US
Practice Address - Phone:509-768-6852
Practice Address - Fax:509-343-1623
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60185163101YA0400X
WA606496351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2088953Medicaid