Provider Demographics
NPI:1881091585
Name:WILKS, PATRICIA (MS)
Entity type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:
Last Name:WILKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:CHOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:267 WASSERMAN RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-4155
Mailing Address - Country:US
Mailing Address - Phone:513-868-5640
Mailing Address - Fax:513-896-5645
Practice Address - Street 1:267 WASSERMAN RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-4155
Practice Address - Country:US
Practice Address - Phone:513-868-5640
Practice Address - Fax:513-896-5645
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3175628103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool