Individual
DR. TYWANDA JILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT-IT,
Contact information
Practice address
14540 S MARQUETTE AVE, BURNHAM, IL 60633-2007
(737) 710-6897
Mailing address
14540 S MARQUETTE AVE, BURNHAM, IL 60633-2007
(773) 710-6897
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1130-228
WI
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1130-228
MARRIGE AND FAMILY THERAPIST
WI
Enumeration date
05/17/2007
Last updated
01/13/2025
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