Provider Demographics
NPI:1164798765
Name:WILSON, KATE (MS CGC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST
Mailing Address - Street 2:SUITE 1217
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3000
Mailing Address - Country:US
Mailing Address - Phone:713-486-2291
Mailing Address - Fax:
Practice Address - Street 1:11914 ASTORIA BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6064
Practice Address - Country:US
Practice Address - Phone:713-486-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS