Provider Demographics
NPI:1235174558
Name:WILSON, KATHERINE K (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:K
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 NORTH COTTAGE STREET
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258
Mailing Address - Country:US
Mailing Address - Phone:559-789-0274
Mailing Address - Fax:
Practice Address - Street 1:175 NORTH COTTAGE STREET
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93258
Practice Address - Country:US
Practice Address - Phone:559-789-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16350103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical