Healthcare Provider Details

I. General information

NPI: 1427868660
Provider Name (Legal Business Name): WHITNEY MICHELE WILSON ALMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N 2ND ST UNIT 203
ST CHARLES IL
60174-1850
US

IV. Provider business mailing address

465 CIMARRON DR W
AURORA IL
60504-5215
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-5105
  • Fax:
Mailing address:
  • Phone: 618-214-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208.001278
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: