Provider Demographics
NPI:1013499656
Name:WASSON, JILLIAN WOODFORD (PHD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:WOODFORD
Last Name:WASSON
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25055 W VALLEY PKWY STE 124
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-8449
Mailing Address - Country:US
Mailing Address - Phone:908-246-1975
Mailing Address - Fax:
Practice Address - Street 1:25055 W VALLEY PKWY STE 124
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-8449
Practice Address - Country:US
Practice Address - Phone:908-246-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TC1900X
KS2701103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling