Individual
ALYSSA K WILDERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, MA
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
178020118
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/14/2022
Last updated
07/13/2025
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