Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6944 | OH |
Y | 103TC1900X | Counseling Psychologist | 6944 | OH |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6944 | OH |
N | 103TF0000X | Family Psychologist | 6944 | OH |
N | 103TR0400X | Rehabilitation Psychologist | 6944 | OH |
NPI | 1497894836 |
---|---|
Provider Name | Jennifer L Wilson |
First Address | San Antonio, TX 78229-4404 |
Second Address | San Antonio, TX 78229-4404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 03/12/2013 |