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General NPI Number Information
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NPI Number | 1114961265
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Entity Type | Individual
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Provider Name | CATHERINE S WILSON PSY.D
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Gender | Female
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 345 E SUPERIOR ST
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City | CHICAGO
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State | IL
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Zip | 60611-2654
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Country | US
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Telephone | 312-238-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 340 E RANDOLPH ST APT 3304
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City | CHICAGO
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State | IL
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Zip | 60601-7418
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Country | US
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Telephone | 847-226-7114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | IL
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