Individual
MR. JORDAN KENT WILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SSP, NCSP
Contact information
Practice address
807 N MATTIS AVE, CHAMPAIGN, IL 61821-2448
(618) 919-0408
(618) 919-0408
Mailing address
807 N MATTIS AVE, CHAMPAIGN, IL 61821-2448
(618) 919-0408
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
IL
Other
Enumeration date
10/25/2017
Last updated
10/25/2017
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