Doctor Name: | DIANA SUE WILKERSON |
NPI Number: | 1457339087 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 5104 |
Business Practice Address: | 1730 Rippling Brook Dr Mansfield, OH - 449041870 |
Business Phone Number: | 4197561318 |
Business Fax Number: | 4195299989 |
Mailing Address: | 1730 Rippling Brook Dr, MANSFIELD |
State: | OH |
Postal Code: | 449041870 |
Phone Number: | 4197561318 |
Fax Number: | 4195299989 |
NPI Enumeration Date: | 01/04/2006 |
NPI Last Update Date: | 08/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 5104 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |