Healthcare Provider Details

I. General information

NPI: 1962751685
Provider Name (Legal Business Name): KATHERINE WILKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE DOWER

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 ZELZAH AVE
NORTHRIDGE CA
91325-2003
US

IV. Provider business mailing address

9650 ZELZAH AVE
NORTHRIDGE CA
91325-2003
US

V. Phone/Fax

Practice location:
  • Phone: 818-993-9311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW77085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: