Individual
MS. EDITH WIRTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 E MAIN ST, ST CHARLES, IL 60174-1948
(630) 587-3777
Mailing address
113 PHEASANT TRL, LAKE IN THE HILLS, IL 60156-1240
(847) 732-4591
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
178008236
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
721576970
TAXPAYER IDENTIFICATION NUMBER
IL
Enumeration date
09/26/2015
Last updated
09/26/2015
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