Healthcare Provider Details

I. General information

NPI: 1952284580
Provider Name (Legal Business Name): JOSLYN CHRISTINA WILSON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 S MICHIGAN AVE STE 900
CHICAGO IL
60604-4393
US

IV. Provider business mailing address

6751 S JEFFERY BLVD APT 217
CHICAGO IL
60649-1239
US

V. Phone/Fax

Practice location:
  • Phone: 813-395-1073
  • Fax: 772-675-9100
Mailing address:
  • Phone: 708-632-6386
  • Fax: 772-675-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-410152
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: