Individual provider · Type 1 NPI

Shannon L. Wilson, LCSW

Clinical Social Worker · Mountain Home Afb, ID

NPI number 1013396175 Active

Practice location

90 Hope Dr Bldg 6000
Mountain Home Afb, ID 83648-1062

Specialties and licenses

Taxonomy	Code	License
Clinical Social Worker Primary	1041C0700X	LCSW-36402 (ID)
Social Worker	104100000X	LMSW-33063 (ID)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1013396175

Shannon L. Wilson, LCSW's National Provider Identifier is 1013396175, issued on May 22, 2015. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Mountain Home Afb, ID. The record was last updated on Dec 1, 2025.