Individual
BAILEY WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
201 PARK PL STE 11, BOURBONNAIS, IL 60914-1883
(614) 806-0495
Mailing address
201 PARK PL STE 11, BOURBONNAIS, IL 60914-1883
(614) 806-0495
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
178.013901
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81-4957995
TAX ID
IL
Enumeration date
12/01/2018
Last updated
12/01/2018
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