Provider Demographics
NPI:1043340334
Name:WILANSKY, NAOMI (MSS LCSW BCD)
Entity Type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:
Last Name:WILANSKY
Suffix:
Gender:F
Credentials:MSS LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BEECH ST
Mailing Address - Street 2:BLDG 10
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1456
Mailing Address - Country:US
Mailing Address - Phone:309-825-8818
Mailing Address - Fax:309-452-1265
Practice Address - Street 1:1100 BEECH ST
Practice Address - Street 2:BLDG 10
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1456
Practice Address - Country:US
Practice Address - Phone:309-825-8818
Practice Address - Fax:309-452-1265
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490087161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
371389823OtherTRICARE
IL005725530OtherBCBS