Provider Demographics
NPI:1689320699
Name:WIJNEN, MARIJKE ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIJKE
Middle Name:ELLEN
Last Name:WIJNEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIJKE
Other - Middle Name:ELLEN
Other - Last Name:WYNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5130 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3908
Mailing Address - Country:US
Mailing Address - Phone:574-323-0983
Mailing Address - Fax:
Practice Address - Street 1:5130 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-3908
Practice Address - Country:US
Practice Address - Phone:708-669-9138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.105443104100000X
IL149.0249931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker