Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

R.l. Wilson, MD, PC

Organization Clinical Social Worker · NPI 1962623249

R.l. Wilson, MD, PC is a Clinical Social Worker in South Bend, Indiana. Licensed in Indiana. Registered with an NPI since 2007.

Licensed in
IN
In the registry since
2007
Specialties on file
2
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

828 E Colfax Ave
South Bend, IN 46617-2804
Phone: (574) 233-5858
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X · Licence 50003038A (IN)
Clinical Social Worker Taxonomy 1041C0700X

Record details

NPI number1962623249
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Rickey Wilson — President · (574) 233-5858
NPI enumeratedMay 2, 2007
Last updated in NPPESSeptember 11, 2025
Mailing address828 E Colfax Ave, South Bend, IN 46617-2804

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