MEDICARE: DR. JANET C. WILSON PH.D., A.B.P.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	081001708	VA
2	103TC0700X	Clinical Psychologist	0810001708	VA

General Provider Information

NPI Number	:	1497846158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET C. WILSON PH.D., A.B.P.P.

Provider Business Mailing Address
First Line	:	617 S TAYLOR ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-1448
Country	:	US
Telephone Number	:	703-521-1127
Fax Number	:	703-521-1127

Provider Business Practice Location Address
First Line	:	617 S TAYLOR ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-1448
Country	:	US
Telephone Number	:	703-521-1127
Fax Number	:	703-521-1127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	09/11/2018

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