Individual
DR. KATHERINE K. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2101 E BROADWAY RD, SUITE 33, TEMPE, AZ 85282-1879
(480) 966-8729
(480) 446-0854
Mailing address
PO BOX 10236, SCOTTSDALE, AZ 85271-0236
(480) 966-8729
(480) 446-0854
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0870
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8886088816
MEDICARE PROVIDER ENROLLM
AZ
Enumeration date
05/07/2007
Last updated
07/08/2007
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