Provider Demographics
NPI:1528078730
Name:WILSON, ALISON JANE (PHD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:JANE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9137 E MINERAL CIR
Mailing Address - Street 2:STE 240
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3423
Mailing Address - Country:US
Mailing Address - Phone:720-383-0869
Mailing Address - Fax:
Practice Address - Street 1:9137 E MINERAL CIR
Practice Address - Street 2:STE 240
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3423
Practice Address - Country:US
Practice Address - Phone:720-383-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31157103TC0700X
CO3274103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1528078730Medicare UPIN
TX441PMedicare ID - Type Unspecified