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General NPI Number Information
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NPI Number | 1720352198
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Entity Type | Individual
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Provider Name | GERALD ANTHONY WYMAN MSW
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Gender | Male
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 3010 GRAND AVE
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City | WAUKEGAN
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State | IL
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Zip | 60085-2321
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Country | US
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Telephone | 847-377-8296
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Fax | 847-984-5689
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Provider Business Mailing Address
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Address Line | 4511 W SWALLOWTAIL DR
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City | WAUKEGAN
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State | IL
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Zip | 60085-8602
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Country | US
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Telephone | 847-662-2499
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.007271
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License Number State | IL
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