Healthcare Provider Details

I. General information

NPI: 1538736350
Provider Name (Legal Business Name): THERESA L WYCKLENDT APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESA L PALMEN

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BURR RIDGE PKWY STE 201
BURR RIDGE IL
60527-0864
US

IV. Provider business mailing address

PO BOX 40412
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 312-818-4650
  • Fax: 855-618-2629
Mailing address:
  • Phone: 312-818-4650
  • Fax: 855-618-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11060-033
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1716711
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: