Doctor Name: | KATHERINE J. WILSON |
NPI Number: | 1326255282 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | |
Business Practice Address: | 700 Se Cross St Mt Sterling, IL - 623531561 |
Business Phone Number: | 2177733325 |
Business Fax Number: | 2177732425 |
Mailing Address: | Route 1, Box 86 TIMEWELL |
State: | IL |
Postal Code: | 62375 |
Phone Number: | 2176172039 |
Fax Number: | 2177732425 |
NPI Enumeration Date: | 05/17/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |