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General NPI Number Information
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NPI Number | 1447936984
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Entity Type | Individual
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Provider Name | MARY ANN VILLALON PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 1203 W AUGUSTA BLVD STE 1
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City | CHICAGO
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State | IL
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Zip | 60642-4327
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Country | US
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Telephone | 773-248-2255
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Fax |
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Provider Business Mailing Address
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Address Line | 8650 W DAVIS ST
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City | DES PLAINES
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State | IL
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Zip | 60016-5167
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Country | US
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Telephone | 224-766-9182
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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 | 209028066
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 041483639
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License Number State | IL
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