Individual
MS. DEJA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5200 MIDLOTHIAN TPKE APT 115, CRESTWOOD, IL 60418-4139
(773) 349-4513
Mailing address
5200 MIDLOTHIAN TPKE APT 115, CRESTWOOD, IL 60418-4139
(773) 349-4513
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
04/27/2023
Last updated
04/27/2023
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