Healthcare Provider Details

I. General information

NPI: 1659166312
Provider Name (Legal Business Name): MACY JO WILHELM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 16TH AVE SW
CEDAR RAPIDS IA
52404-2363
US

IV. Provider business mailing address

PO BOX 155
PRESTON IA
52069-0155
US

V. Phone/Fax

Practice location:
  • Phone: 319-390-4611
  • Fax: 319-390-4381
Mailing address:
  • Phone: 563-209-5841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: