Healthcare Provider Details

I. General information

NPI: 1730091034
Provider Name (Legal Business Name): TIMOTHY JOSEPH WINKLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 N HARKER DR
PEORIA IL
61615-1850
US

IV. Provider business mailing address

1213 E FRYE AVE
PEORIA IL
61603-3309
US

V. Phone/Fax

Practice location:
  • Phone: 309-408-1493
  • Fax: 309-473-8697
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: