Healthcare Provider Details

I. General information

NPI: 1649193855
Provider Name (Legal Business Name): JENSINE P WYANT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11191 ILLINOIS ROUTE 185
HILLSBORO IL
62049-2664
US

IV. Provider business mailing address

14171 WITT AVE
WITT IL
62094-2031
US

V. Phone/Fax

Practice location:
  • Phone: 217-532-2001
  • Fax:
Mailing address:
  • Phone: 217-820-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.129951
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: