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NPI Code Detail

MEDICARE: CHARLOM WILCHER

MEDICARE: CHARLOM WILCHER
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3106S00000XBehavior Technician
4104100000XSocial Worker

General Provider Information

NPI Number : 1700775285
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLOM WILCHER
Provider Business Mailing Address
First Line : 8700 S DANTE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60619-7118
Country : US
Telephone Number : 773-495-5091
Fax Number :
Provider Business Practice Location Address
First Line : 8700 S DANTE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60619-7118
Country : US
Telephone Number : 833-717-4244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2025
Last Update Date : 06/30/2025

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