Provider Demographics
NPI:1013416957
Name:WILSON, KATHERINE E
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2058
Mailing Address - Country:US
Mailing Address - Phone:330-343-6631
Mailing Address - Fax:330-343-8188
Practice Address - Street 1:201 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2058
Practice Address - Country:US
Practice Address - Phone:330-343-6631
Practice Address - Fax:330-343-8188
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician