Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | IL | |
Y | 103TC0700X | Clinical Psychologist | IL |
NPI | 1003095993 |
---|---|
Provider Name | Beth I Wilner |
First Address | Schaumburg, IL 60173-5405 |
Second Address | Schaumburg, IL 60173-5405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2007 |
Last Update Date | 29/10/2007 |