Katherine L. Wilson, PSY. D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY30173 Issued in CA

Practice address

5130 Vista Sierra Dr
Antelope, CA 95843-4610

Phone

(916) 715-9069

NPI assigned

Jun 18, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660867200000",
    "number": "1134440613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8803",
            "city": "CITRUS HEIGHTS",
            "state": "CA",
            "postal_code": "956218803",
            "telephone_number": "916-715-9069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5130 VISTA SIERRA DR",
            "city": "ANTELOPE",
            "state": "CA",
            "postal_code": "958434610",
            "telephone_number": "916-715-9069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5750 Sunrise Blvd Ste 130-F",
            "address_purpose": "LOCATION",
            "city": "Citrus Heights",
            "state": "CA",
            "postal_code": "956107634",
            "country_code": "US",
            "telephone_number": "916-715-9069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KATHERINE",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "PSY. D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-18",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY30173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Antelope, CA
• Providers in Antelope, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.