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General NPI Number Information
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NPI Number | 1851628762
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Entity Type | Individual
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Provider Name | FLORENTINE FRANCES WILK PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/13/2009
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 75 MARKET ST
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City | ELGIN
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State | IL
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Zip | 60123-5093
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Country | US
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Telephone | 847-931-9455
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 747
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City | DUNDEE
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State | IL
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Zip | 60118-0747
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Country | US
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Telephone | 847-931-9455
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071004951
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 041104199
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License Number State | IL
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