Individual
BAILEY ELIZABETH WAHLQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
141 MARKET PL, SUITE 206, FAIRVIEW HEIGHTS, IL 62208-2034
(618) 398-7250
(618) 398-6870
Mailing address
141 MARKET PL, SUITE 206, FAIRVIEW HEIGHTS, IL 62208-2034
(618) 398-7250
(618) 398-6870
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12287066
CAQH
—
Enumeration date
10/01/2008
Last updated
11/03/2011
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