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Individual

DR. IRENE AI-LING WILES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
559 VINCENT ST, PETERSON AFB, CO 80914-1541
(719) 556-4762
Mailing address
559 VINCENT ST, PETERSON AFB, CO 80914-1541

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
103TC0700X
Clinical Psychologist
Primary
PSY.0004777
CO
103TC0700X
Clinical Psychologist
PSY24257
CA

Other

Enumeration date
07/30/2007
Last updated
04/05/2019
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