Individual
TASHAE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
450 W 14TH ST, CHICAGO HEIGHTS, IL 60411
(708) 444-1012
Mailing address
17746 OAK PARK AVE, TINLEY PARK, IL 60477-3936
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/17/2015
Last updated
07/19/2018
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