Provider Demographics
NPI:1063832426
Name:WILKINSON, KATHERINE A (MA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 MUTUAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-4238
Mailing Address - Country:US
Mailing Address - Phone:260-797-6070
Mailing Address - Fax:
Practice Address - Street 1:6315 MUTUAL DR STE B
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4238
Practice Address - Country:US
Practice Address - Phone:260-797-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003293A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health