Provider Demographics
NPI:1093946568
Name:WILKERSON, ANNETTE JOSEPHINE
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:JOSEPHINE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 W ROSEMONT AVE
Mailing Address - Street 2:APT. 3E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1323
Mailing Address - Country:US
Mailing Address - Phone:773-764-5807
Mailing Address - Fax:
Practice Address - Street 1:1536 W ROSEMONT AVE
Practice Address - Street 2:APT. 3E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1323
Practice Address - Country:US
Practice Address - Phone:773-764-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2009-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist