Doctor Name: | DR. SALLY L. WILSON |
NPI Number: | 1194890285 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 3535 |
Business Practice Address: | 2600 Lander Rd # 117 Pepper Pike, OH - 441244320 |
Business Phone Number: | 4404429355 |
Business Fax Number: | 4404424587 |
Mailing Address: | 2600 Lander Rd # 117, PEPPER PIKE |
State: | OH |
Postal Code: | 441244320 |
Phone Number: | 4404429355 |
Fax Number: | 4404424587 |
NPI Enumeration Date: | 11/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 3535 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |