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1669661872 NPI number — ELIZABETH JEAN WILTON MA, LCPC

NPI Number: 1669661872
Health Care Provider/Practitioner: ELIZABETH JEAN WILTON MA, LCPC

Information about “1669661872” NPI (ELIZABETH JEAN WILTON MA, LCPC) exists in 1669661872 in HTML format HTML  |  1669661872 in plain Text format TXT  |  1669661872 in PDF (Portable Document Format) PDF  |  1669661872 in an XML format XML  formats.

NPI Number : 1669661872 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669661872",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILTON",
    "FirstName": "ELIZABETH",
    "MiddleName": "JEAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA, LCPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7523 N CLAREMONT AVE",
    "SecondLineMailingAddress": "UNIT G",
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60645-1514",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-396-8607",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2526 N LINCOLN AVE",
    "SecondLinePracticeLocationAddress": "SUITE 218",
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60614-2353",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-574-7574",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/24/2007",
    "LastUpdateDate": "02/19/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "11/30/2018",
    "NPIReactivationDate": "02/19/2019",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "180006152",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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