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General NPI Number Information
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NPI Number | 1588129779
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Entity Type | Individual
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Provider Name | AUDREY WILSON LCPC, CADC, CTP
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Gender | Female
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 800 E DIEHL RD STE 100
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City | NAPERVILLE
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State | IL
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Zip | 60563-2389
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Country | US
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Telephone | 630-740-8922
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 N MILL ST
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City | NAPERVILLE
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State | IL
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Zip | 60563-2261
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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 |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 178.012889
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License Number State | IL
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