MEDICARE: AMY J WILDER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1225081557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY J WILDER LCSW

Provider Business Mailing Address
First Line	:	2025 S ARLINGTON HEIGHTS RD
Second Line	:	SUITE 112
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 S ARLINGTON HEIGHTS RD
Second Line	:	SUITE 112
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-4152
Country	:	US
Telephone Number	:	847-545-0400
Fax Number	:	847-545-0405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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