Provider Demographics
NPI:1528312725
Name:WILSON, ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:AZ
Mailing Address - Zip Code:86331-0173
Mailing Address - Country:US
Mailing Address - Phone:713-300-0713
Mailing Address - Fax:
Practice Address - Street 1:15750 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94578-1012
Practice Address - Country:US
Practice Address - Phone:713-300-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22450103TC0700X
TX36477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical