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General NPI Number Information
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NPI Number | 1336687144
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Entity Type | Individual
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Provider Name | STEPHANIE J. WILSON PMHNP
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Gender | Female
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 641 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60621-2032
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Country | US
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Telephone | 773-580-5190
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Fax |
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Provider Business Mailing Address
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Address Line | 3736 W 78TH ST
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City | CHICAGO
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State | IL
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Zip | 60652-1826
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Country | US
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Telephone | 773-580-5190
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ01480900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 404928
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | TEMP328406
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 377002534
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277002629
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.391640
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71016307A
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License Number State | IN
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