Provider Demographics
NPI:1508359373
Name:WILGES, JANETT M
Entity Type:Individual
Prefix:
First Name:JANETT
Middle Name:M
Last Name:WILGES
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45354-0247
Mailing Address - Country:US
Mailing Address - Phone:937-554-5825
Mailing Address - Fax:
Practice Address - Street 1:302 FERNWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:OH
Practice Address - Zip Code:45354-0247
Practice Address - Country:US
Practice Address - Phone:937-554-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0020981104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker