Provider Demographics
NPI:1003095993
Name:WILNER, BETH I (PHD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:I
Last Name:WILNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N PLAZA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5405
Mailing Address - Country:US
Mailing Address - Phone:847-619-1880
Mailing Address - Fax:847-619-1882
Practice Address - Street 1:999 N PLAZA DR STE 300
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5405
Practice Address - Country:US
Practice Address - Phone:847-619-1880
Practice Address - Fax:847-619-1882
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical