Provider Demographics
NPI:1437896479
Name:WILSON, BROOKE (MSW CSW-I)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW CSW-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 KEYSTONE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5571
Mailing Address - Country:US
Mailing Address - Phone:775-510-3797
Mailing Address - Fax:
Practice Address - Street 1:85 KEYSTONE AVE STE 203
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5571
Practice Address - Country:US
Practice Address - Phone:775-510-3797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9323-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical