Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 71007245 | IL |
Y | 103TC0700X | Clinical Psychologist | 71007245 | IL |
N | 103G00000X | Clinical Psychologist | 71007245 | IL |
N | 103TC0700X | Clinical Psychologist | 71007245 | IL |
N | 103TH0004X | Health Psychologist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1619090719 |
---|---|
Provider Name | Anne H. Wiley |
First Address | Chicago, IL 60618-1609 |
Second Address | Chicago, IL 60618-1609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/04/2015 |