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KATHRYN WILSON P.D.
NPI 1235423104
Clinical Neuropsychologist in Detroit, MI

Active since June 08, 2011PECOS Enrolled
1 FORD PL STE 1F, DETROIT, MI 48202(313) 874-4907 Get Directions Write a Review

NPPES record last updated: August 28, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 28, 2023, Feb 15, 2017 (2 updates tracked since 2017).

About Kathryn Wilson P.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KATHRYN WILSON P.D. (NPI 1235423104) is an individual clinical neuropsychologist in Detroit, Michigan, licensed in Michigan (6301014211) and active in the NPI registry since June 2011. She is enrolled in Medicare PECOS and maintains a secondary practice location in Grand Rapids.

NPPES Registry Identity

NPI1235423104
Entity TypeIndividualFemale
Primary Taxonomy103G00000X
Provider Legal NameKATHRYN WILSONCredential: P.D.
Location Address1 FORD PL STE 1FDetroit, MI 48202-3450
Mailing Address235 Wealthy St SeGrand Rapids, MI 49503-5247 · (616) 840-8000 · Fax (616) 840-9762
Phone(313) 874-4907
Sole ProprietorNo
Enumeration DateJune 8, 2011
Last NPPES UpdateAugust 28, 20232 updates tracked since enumeration
NPPES CertifiedAugust 28, 2023
✔ NPI 1235423104 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers
Taxonomy Code103G00000X
License✔ Licensed in MI · 6301014211
Definition
A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.
Also ListedPsychologist · RehabilitationTaxonomy 103TR0400X · License 6301014211 (MI)
1 FORD PL STE 1F, Detroit, MI 48202
Open in Google Maps ↗

Secondary Practice Location 1

Location 1235 Wealthy St SEGrand Rapids, MI 49503-5247 · Phone (616) 840-8000 · Fax (616) 840-9762

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kathryn Wilson P.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kathryn Wilson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Henry Ford Health System
0.6 mi
Clinical
2799 W GRAND BLVD
Detroit, MI 48202
  • Reassigned Medicare billing, Michigan enrollment
  • 52 clinicians in this Medicare group
NPI 1114001468 (313) 916-2600

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TIWALOLA OLUFUNKE OSUNFISAN M.D
Psychiatry & Neurology (Psychiatry)
1 FORD PL STE 1F
DETROIT, MI 48202
Wayne County (800) 653-6568
ESTAVANICA RIES LMSW
Social Worker (Clinical)
1 FORD PL STE 1F
DETROIT, MI 48202
Wayne County (313) 874-6677

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kathryn Wilson's NPI number?

The NPI number for Kathryn Wilson is 1235423104. It was assigned to this individual provider in the NPPES registry on June 8, 2011.

Where is Kathryn Wilson located?

Kathryn Wilson practices at 1 Ford Pl Ste 1F, Detroit, MI 48202. The listed phone number is (313) 874-4907.

What is Kathryn Wilson's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Is Kathryn Wilson enrolled in Medicare?

Yes. Kathryn Wilson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kathryn Wilson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kathryn Wilson reassigns Medicare benefits to Henry Ford Health System (Detroit, MI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kathryn Wilson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kathryn Wilson accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 2 other insurers list Kathryn Wilson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kathryn Wilson was last updated on August 28, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.