Active NPI
Kathryn Wilson, P.D.
- Clinical Neuropsychologist
- Detroit, MI
National Provider Identifier
1235423104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 6301014211
- Practice address
- 1 Ford PL Ste 1F
Detroit, MI 48202-3450 - Phone
- (313) 874-4907
- NPI assigned
- Jun 8, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | 6301014211 | MI | |
| Clinical Neuropsychologist | 103G00000X | 6301014211 | MI | Primary |
Addresses
Primary practice location
1 Ford PL Ste 1F
Detroit, MI 48202-3450
Mailing address
235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone (616) 840-8000
Other practice location 1
235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone (616) 840-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mary Free Bed Rehabilitation Hospital | Past | Accepting new patients |
Interoperability endpoints
- kwilson891242@direct.hfhs.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Medicine & Rehabilitation Physician
- Grand Rapids, MI
- NPI 1053641589
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693180800000",
"number": "1235423104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "235 WEALTHY ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495035247",
"telephone_number": "616-840-8000",
"fax_number": "616-840-9762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 FORD PL STE 1F",
"city": "DETROIT",
"state": "MI",
"postal_code": "482023450",
"telephone_number": "313-874-4907"
}
],
"practiceLocations": [
{
"address_1": "235 Wealthy St SE",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495035247",
"country_code": "US",
"telephone_number": "616-840-8000",
"fax_number": "616-840-9762",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "KATHRYN",
"credential": "P.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-08",
"last_updated": "2023-08-28",
"certification_date": "2023-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "MI",
"license": "6301014211",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MI",
"license": "6301014211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.