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Individual

JENNIFER WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
2864 S CIRCLE DR, SUITE 600, COLORADO SPRINGS, CO 80906-4114
(719) 314-4260
(716) 264-6614
Mailing address
8335 IVORY LOOP, PEYTON, CO 80831-6761
(719) 302-1276

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
0833
NM
103T00000X
Psychologist
Primary
3042
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
56054556
NM
Enumeration date
04/30/2007
Last updated
07/08/2007
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