Provider Demographics
NPI:1952141632
Name:WILES, KATHERINE (MSW, ACSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WILES
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10144 E BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9411
Mailing Address - Country:US
Mailing Address - Phone:408-307-2425
Mailing Address - Fax:
Practice Address - Street 1:317 W BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6077
Practice Address - Country:US
Practice Address - Phone:408-307-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114824104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty