Provider Demographics
NPI:1093407173
Name:JESSICA WILEY THERAPY, LLC
Entity Type:Organization
Organization Name:JESSICA WILEY THERAPY, LLC
Other - Org Name:JESSICA WILEY THERAPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-819-0043
Mailing Address - Street 1:1801 WOODFIELD DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-9505
Mailing Address - Country:US
Mailing Address - Phone:217-819-0043
Mailing Address - Fax:
Practice Address - Street 1:1801 WOODFIELD DR STE 106
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9505
Practice Address - Country:US
Practice Address - Phone:217-819-0043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty