Individual
AMY RENEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1167 CORPORATE LAKE DR, SAINT LOUIS, MO 63132-1716
(314) 968-2350
Mailing address
1167 CORPORATE LAKE DR, SAINT LOUIS, MO 63132-1716
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
MO
103TC0700X
Clinical Psychologist
Primary
13829
CO
Other
Enumeration date
09/27/2010
Last updated
07/01/2021
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