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General NPI Number Information
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NPI Number | 1083717490
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Entity Type | Individual
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Provider Name | JAMIE L WASILEWSKI PHD
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Gender | Female
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 319 E MADISON ST FL 3
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City | SPRINGFIELD
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State | IL
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Zip | 62701-1035
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Country | US
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Telephone | 217-545-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E MADISON ST STE 328
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City | SPRINGFIELD
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State | IL
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Zip | 62702-5131
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Country | US
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Telephone | 217-545-8000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1535
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.010808
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License Number State | IL
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