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General NPI Number Information
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NPI Number | 1134440613
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Entity Type | Individual
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Provider Name | KATHERINE L. WILSON PSY. D
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Gender | Female
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 5130 VISTA SIERRA DR
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City | ANTELOPE
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State | CA
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Zip | 95843-4610
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Country | US
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Telephone | 916-715-9069
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8803
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95621-8803
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Country | US
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Telephone | 916-715-9069
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY30173
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License Number State | CA
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