MEDICARE: DR. CATHERINE S WILSON PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist		IL

General Provider Information

NPI Number	:	1114961265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE S WILSON PSY.D

Provider Business Mailing Address
First Line	:	340 E RANDOLPH ST
Second Line	:	APT 3304
City	:	CHICAGO
State	:	IL
Zip	:	60601-7418
Country	:	US
Telephone Number	:	847-226-7114
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 E SUPERIOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2654
Country	:	US
Telephone Number	:	312-238-1115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	03/31/2008

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