Individual
SHANNON MARIE JOHNSON WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2200 SW GAGE BLVD, TOPEKA, KS 66622-0001
(785) 350-3111
Mailing address
2200 SW GAGE BLVD, TOPEKA, KS 66622-0001
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
377657
WI
Other
Enumeration date
03/30/2020
Last updated
03/30/2020
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