Individual
DR. PAUL D WILLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1015 S MERCER AVE, BLOOMINGTON, IL 61701-7107
(309) 706-3190
(309) 452-9028
Mailing address
PO BOX 604, BLOOMINGTON, IL 61702-0604
(309) 706-3190
(309) 452-9028
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.007268
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05732025
BLUE CROSS BLUE SHIELD
IL
01
—
117151
HEALTH ALLIANCE
IL
01
—
K39590
MEDICARE
IL
Enumeration date
05/03/2007
Last updated
08/07/2009
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