Individual
MRS. MARY ANN WILDWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
202 S. PERSHING ST., GOYA HEALTH LTD., ENERGY, IL 62933
(618) 988-9843
(618) 942-8640
Mailing address
P.O. BOX 100, GOYA HEALTH LTD., ENERGY, IL 62933
(618) 988-9843
(618) 942-8640
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
149005571
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800012395
RR MEDICARE
IL
Enumeration date
05/24/2006
Last updated
04/30/2014
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