Individual
KENDRA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
333 N LA GRANGE RD, LA GRANGE PARK, IL 60526-5646
(708) 745-5277
(708) 698-5090
Mailing address
14614 THOMAS JEFFERSON DR, PLAINFIELD, IL 60544-4424
(779) 279-3372
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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