Jennifer Wilson, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3042 Issued in CO

Practice address

2864 S Circle Dr
Suite 600
Colorado Springs, CO 80906-4114

Phone

(719) 314-4260

Fax

(716) 264-6614

NPI assigned

Apr 30, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2019 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Diversus Health Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Colorado Springs, CO
  • NPI 1295269561
  NPD (past)
• Hoffler & Associates Counseling Services, Inc

  • Community/Behavioral Health Agency
  • Colorado Springs, CO
  • NPI 1295825040
  NPD (past)

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

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285854364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8335 IVORY LOOP",
            "city": "PEYTON",
            "state": "CO",
            "postal_code": "808316761",
            "telephone_number": "719-302-1276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2864 S CIRCLE DR",
            "address_2": "SUITE 600",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064114",
            "telephone_number": "719-314-4260",
            "fax_number": "716-264-6614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JENNIFER",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "3042",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NM",
            "license": "0833",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56054556",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Emily Wilson
• Gabrielle Inez Wilson, DPT
• Ginamarie Cittadini Wilson, NP
• Jacob Allen Wilson, PMHNP-BC
• Jenna Wilson
• Jennifer Downey Wilson, PT, DPT, PCS
• Joe Wilson, D.D.S.
• Karen Evonne Wilson, M.S., R.D., PA-C
• Keyona M Wilson
• Kimberley Wilson

• Psychologist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.