Individual
ELIZABETH WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3008 HAPPY LANDING DR, SPRINGFIELD, IL 62711-6259
(630) 428-7890
Mailing address
2772 JAMAR TRL APT 206, DECATUR, IL 62521-2373
(618) 558-0644
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149023240
IL
Other
Enumeration date
04/21/2021
Last updated
04/21/2021
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