Provider Demographics
NPI:1861655540
Name:WILSON, KATRIJN SEYNNAEVE (MD)
Entity Type:Individual
Prefix:
First Name:KATRIJN
Middle Name:SEYNNAEVE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 W HIGHWAY 290 STE 108
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8827
Mailing Address - Country:US
Mailing Address - Phone:512-430-1130
Mailing Address - Fax:512-677-6806
Practice Address - Street 1:5424 W HIGHWAY 290 STE 108
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8827
Practice Address - Country:US
Practice Address - Phone:512-430-1130
Practice Address - Fax:512-677-6806
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4428532084P0804X
TXP84322084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry