Wilton Jan Wielenga, LCSW
Social Worker, Clinical in Stockton, CA. Individual provider (NPI-1).
NPI number1528126703
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1528126703
- Entity type
- Individual (NPI-1)
- Name
- Mr. Wilton Jan Wielenga
- Credential
- LCSW
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 4, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | LCS 5681 | CA | Yes |
Practice location
1755 W Hammer LaneSuite 1
Stockton, CA 95209-2900
Phone 209-477-9180
Mailing address
1755 W Hammer LaneSuite 1
Stockton, CA 95209-2900
Phone 209-477-9180 · Fax 209-952-8520
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