Healthcare Provider Details

I. General information

NPI: 1295648814
Provider Name (Legal Business Name): AHSI LAVON WILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18350 CROSSING DR
TINLEY PARK IL
60487-6294
US

IV. Provider business mailing address

7029 SOUTHEASTERN AVE
HAMMOND IN
46324-2129
US

V. Phone/Fax

Practice location:
  • Phone: 708-342-5200
  • Fax:
Mailing address:
  • Phone: 708-342-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.118327
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: