Healthcare Provider Details

I. General information

NPI: 1215848189
Provider Name (Legal Business Name): MS. RACHEL SUSAN WILBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20550 S LAGRANGE RD
FRANKFORT IL
60423-1397
US

IV. Provider business mailing address

254 N PRAIRIE RD UNIT 204
NEW LENOX IL
60451-2196
US

V. Phone/Fax

Practice location:
  • Phone: 708-614-6860
  • Fax:
Mailing address:
  • Phone: 219-242-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: