Provider Demographics
NPI:1093818114
Name:WEXSTTEN, DARLA B (MSW, LCSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:B
Last Name:WEXSTTEN
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 LINCOLNSHIRE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2189
Mailing Address - Country:US
Mailing Address - Phone:618-242-4205
Mailing Address - Fax:618-242-4209
Practice Address - Street 1:4230 LINCOLNSHIRE DR
Practice Address - Street 2:SUITE E
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2189
Practice Address - Country:US
Practice Address - Phone:618-242-4205
Practice Address - Fax:618-242-4209
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILTRICAREOtherLCSW
ILAETNA 5424723OtherLCSW
ILBC/BS 04132009OtherLCSW
ILBC/BS 04132009OtherLCSW