Provider Demographics
NPI:1225208804
Name:WILCOX, JEAN EDMONDSON (PHD, PSYD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:EDMONDSON
Last Name:WILCOX
Suffix:
Gender:F
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N ST
Mailing Address - Street 2:UNIT 1204
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-4312
Mailing Address - Country:US
Mailing Address - Phone:916-448-1861
Mailing Address - Fax:
Practice Address - Street 1:500 N ST
Practice Address - Street 2:UNIT 1204
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-4312
Practice Address - Country:US
Practice Address - Phone:916-448-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical