Provider Demographics
NPI:1619205010
Name:WILEY, AMY JEAN (MA LCPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEAN
Last Name:WILEY
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK PL
Mailing Address - Street 2:SUITE 24
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1885
Mailing Address - Country:US
Mailing Address - Phone:815-935-0333
Mailing Address - Fax:815-928-9200
Practice Address - Street 1:201 PARK PL
Practice Address - Street 2:SUITE 24
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1885
Practice Address - Country:US
Practice Address - Phone:815-935-0333
Practice Address - Fax:815-928-9200
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007352101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor