MEDICARE: KATHERINE JADE WILAND MSC

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	103T00000X	Psychologist
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1982343117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE JADE WILAND MSC

Provider Business Mailing Address
First Line	:	18245 N PIMA RD APT 3073
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-6374
Country	:	US
Telephone Number	:	310-819-2271
Fax Number	:

Provider Business Practice Location Address
First Line	:	18245 N PIMA RD APT 3073
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-6374
Country	:	US
Telephone Number	:	310-819-2271
Fax Number	:

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

Provider Enumeration Date	:	06/04/2022
Last Update Date	:	06/04/2022

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