Provider Demographics
NPI:1194472456
Name:WILEY, JANET (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10257 STATE ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278-4418
Mailing Address - Country:US
Mailing Address - Phone:717-446-1136
Mailing Address - Fax:
Practice Address - Street 1:520 FULLERTON RD
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2901
Practice Address - Country:US
Practice Address - Phone:618-688-2459
Practice Address - Fax:618-257-0641
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0243611041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health