Individual
AMY WILDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
111 E MAIN ST, ST CHARLES, IL 60174-1948
(630) 587-3777
Mailing address
1110 UNION ST, GENEVA, IL 60134-1241
(630) 414-7816
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
149.016068
IL
101YP2500X
Professional Counselor
149.016068
IL
Other
Enumeration date
08/17/2014
Last updated
08/17/2014
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