Organization
WISE WILLOW INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY M JENKINS LCPC (PRESIDENT)
(708) 275-0934
Entity
Organization
Contact information
Practice address
10522 S CICERO AVE STE 304, OAK LAWN, IL 60453-5292
(708) 275-0934
(888) 419-1594
Mailing address
PO BOX 764, MANTENO, IL 60950-0764
(708) 275-0934
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/23/2024
Last updated
01/22/2025
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