Healthcare Provider Details

I. General information

NPI: 1699349803
Provider Name (Legal Business Name): MOLLY KENNEDY WILKINSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST STE 220
SAN DIEGO CA
92123-2781
US

IV. Provider business mailing address

3020 CHILDRENS WAY MC5003
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-8974
  • Fax:
Mailing address:
  • Phone: 858-576-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY36701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: