Individual
KELSEY NICOLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1 JEFFERSON BARRACKS DR, SAINT LOUIS, MO 63125-4181
(314) 652-4100
Mailing address
516 DIETRICH RD, BALLWIN, MO 63021-8019
(816) 646-2273
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2009039905
MO
Other
Enumeration date
08/09/2021
Last updated
08/09/2021
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