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General NPI Number Information
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NPI Number | 1871617522
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Entity Type | Individual
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Provider Name | MARY JANE WILKIE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 2359 HIGHWAY 105 CDSA OF THE BLUE RIDGE
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City | BOONE
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State | NC
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Zip | 28607-7814
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Country | US
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Telephone | 828-265-5391
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Fax |
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Provider Business Mailing Address
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Address Line | 169 ROGERS DR
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City | BOONE
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State | NC
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Zip | 28607-4825
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Country | US
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Telephone | 828-265-4513
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2487
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License Number State | NC
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