Healthcare Provider Details

I. General information

NPI: 1669668141
Provider Name (Legal Business Name): NICK D WILHELM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 N TALMAN AVE
CHICAGO IL
60622-1630
US

IV. Provider business mailing address

1529 N TALMAN AVE
CHICAGO IL
60622-1630
US

V. Phone/Fax

Practice location:
  • Phone: 312-505-9809
  • Fax:
Mailing address:
  • Phone: 312-505-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: