MEDICARE: DR. ANN 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	PSY22450	CA
2	103TC0700X	Clinical Psychologist	36477	TX

General Provider Information

NPI Number	:	1528312725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN WILSON PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 173
Second Line	:
City	:	JEROME
State	:	AZ
Zip	:	86331-0173
Country	:	US
Telephone Number	:	713-300-0713
Fax Number	:

Provider Business Practice Location Address
First Line	:	15750 FOOTHILL BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94578-1012
Country	:	US
Telephone Number	:	713-300-0713
Fax Number	:

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

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	06/18/2025

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