Provider Demographics
NPI:1336025790
Name:WILSON, KACI (PSYD)
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4170 SAGE BRUSH CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-8225
Mailing Address - Country:US
Mailing Address - Phone:715-495-0064
Mailing Address - Fax:
Practice Address - Street 1:1573 W FAIRBANKS AVE STE 220
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4679
Practice Address - Country:US
Practice Address - Phone:407-303-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist