Healthcare Provider Details

I. General information

NPI: 1801109897
Provider Name (Legal Business Name): MARY A WILSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 SW 6TH AVE
TOPEKA KS
66606-2084
US

IV. Provider business mailing address

3707 SW 6TH AVE
TOPEKA KS
66606-2084
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-4600
  • Fax: 785-270-4628
Mailing address:
  • Phone: 785-270-4600
  • Fax: 785-270-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2225
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: