Provider Demographics
NPI:1710875372
Name:WILSON, JULIA (PA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 N OAKLAND AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1645
Mailing Address - Country:US
Mailing Address - Phone:717-575-6102
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 629
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5222
Practice Address - Country:US
Practice Address - Phone:626-219-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis