Provider Demographics
NPI:1801196647
Name:BROWN-WILSON, CHRISTERRALYN ALYCE JEON
Entity Type:Individual
Prefix:MS
First Name:CHRISTERRALYN
Middle Name:ALYCE JEON
Last Name:BROWN-WILSON
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 1:381 W 16TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3245
Mailing Address - Country:US
Mailing Address - Phone:708-228-9583
Mailing Address - Fax:
Practice Address - Street 1:381 W 16TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3245
Practice Address - Country:US
Practice Address - Phone:708-228-9583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist