Individual
SAMANTHA L. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
13800 W NORTH AVE, CHILD DEVELOPMENT CENTER, BROOKFIELD, WI 53005-4977
(262) 432-6600
(262) 432-6604
Mailing address
13800 W NORTH AVE, CHILD DEVELOPMENT CENTER, BROOKFIELD, WI 53005-4977
(262) 432-6600
(262) 432-6604
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2754
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326290115
—
WI
Enumeration date
10/13/2008
Last updated
10/18/2012
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