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General NPI Number Information
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NPI Number | 1548882954
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Entity Type | Organization
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Legal Business Name | JILLIAN M. WICKERY, PH.D., PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 422 N NORTHWEST HWY STE 230
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City | PARK RIDGE
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State | IL
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Zip | 60068-3261
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Country | US
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Telephone | 847-282-0232
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Fax |
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Provider Business Mailing Address
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Address Line | 422 N NORTHWEST HWY STE 230
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City | PARK RIDGE
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State | IL
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Zip | 60068-3261
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JILLIAN M. WICKERY
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Credential | PH.D.
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Telephone | 847-282-0232
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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 |
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License Number State |
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