Provider Demographics
NPI:1629514666
Name:WIORA, JAMIE L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:L
Last Name:WIORA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:HALLORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6040 STATE ROUTE 53 STE B
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3394
Mailing Address - Country:US
Mailing Address - Phone:630-601-3888
Mailing Address - Fax:630-524-2311
Practice Address - Street 1:6040 STATE ROUTE 53 STE B
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532
Practice Address - Country:US
Practice Address - Phone:630-601-3888
Practice Address - Fax:630-524-2311
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-14
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0143471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical