Healthcare Provider Details

I. General information

NPI: 1881091585
Provider Name (Legal Business Name): PATRICIA WILKS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA CHOU M.S.

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 WASSERMAN RD
HAMILTON OH
45013-4155
US

IV. Provider business mailing address

267 WASSERMAN RD
HAMILTON OH
45013-4155
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-5640
  • Fax: 513-896-5645
Mailing address:
  • Phone: 513-868-5640
  • Fax: 513-896-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH3175628
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: