Healthcare Provider Details

I. General information

NPI: 1174807804
Provider Name (Legal Business Name): ASHLEY M WILKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 E CALIFORNIA BLVD
PASADENA CA
91106-3847
US

IV. Provider business mailing address

26001 REDLANDS BLVD
REDLANDS CA
92373-7762
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-7910
  • Fax:
Mailing address:
  • Phone: 909-825-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29513
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberNONE
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: