Individual
MS. CHEA WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
112 CHEVY CHASE DR, BELLEVILLE, IL 62223-4120
(618) 960-8167
Mailing address
112 CHEVY CHASE DR, BELLEVILLE, IL 62223-4120
(618) 960-8167
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.031495
IL
222Q00000X
Developmental Therapist
—
IL
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
03/18/2016
Last updated
03/19/2026
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