Provider Demographics
NPI:1073799441
Name:WILPOWER, UNC.
Entity Type:Organization
Organization Name:WILPOWER, UNC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-501-2939
Mailing Address - Street 1:444 W FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3009
Mailing Address - Country:US
Mailing Address - Phone:847-501-2939
Mailing Address - Fax:
Practice Address - Street 1:401 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1825
Practice Address - Country:US
Practice Address - Phone:847-501-2939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty