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Individual

KATHRYN WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.D.

Contact information

Practice address
1 FORD PL STE 1F, DETROIT, MI 48202-3450
(313) 874-4907
Mailing address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8000
(616) 840-9762

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6301014211
MI
103TR0400X
Rehabilitation Psychologist
6301014211
MI

Other

Enumeration date
06/08/2011
Last updated
08/28/2023
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