Provider Demographics
NPI:1669661872
Name:WILTON, ELIZABETH JEAN (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JEAN
Last Name:WILTON
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 1:7523 N CLAREMONT AVE
Mailing Address - Street 2:UNIT G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1514
Mailing Address - Country:US
Mailing Address - Phone:773-396-8607
Mailing Address - Fax:
Practice Address - Street 1:2526 N LINCOLN AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2353
Practice Address - Country:US
Practice Address - Phone:847-574-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2019-02-19
Deactivation Date:2018-11-30
Deactivation Code:
Reactivation Date:2019-02-19
Provider Licenses
StateLicense IDTaxonomies
IL180006152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional