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General NPI Number Information
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NPI Number | 1326258864
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Entity Type | Individual
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Provider Name | L. JANE WILSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 809 W CHURCH ST
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3320
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Country | US
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Telephone | 217-373-1850
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Fax | 217-373-1856
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Provider Business Mailing Address
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Address Line | 1398 EAST 2250 NORTH ROAD
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City | WHITE HEATH
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State | IL
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Zip | 61884-0000
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Country | US
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Telephone | 217-687-4132
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Fax | 217-373-1856
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | IL
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