Healthcare Provider Details

I. General information

NPI: 1497326987
Provider Name (Legal Business Name): JALINA WILHELMI M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 STANLEY AVE
BERWYN IL
60402-3130
US

IV. Provider business mailing address

6415 STANLEY AVE
BERWYN IL
60402-3130
US

V. Phone/Fax

Practice location:
  • Phone: 708-995-3660
  • Fax:
Mailing address:
  • Phone: 708-995-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: