Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 102L00000X | Psychologist | 2701 | KS |
Y | 103T00000X | Psychologist | 2701 | KS |
N | 102L00000X | Psychologist | T-LP2621 | KS |
N | 103T00000X | Psychologist | T-LP2621 | KS |
N | 103TC1900X | Counseling Psychologist |
NPI | 1013499656 |
---|---|
Provider Name | Jillian Woodford Wasson |
First Address | Olathe, KS 66215-4825 |
Second Address | Overland Park, KS 66210-1527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 01/07/2019 |