Provider Demographics
NPI:1851628762
Name:WILK, FLORENTINE FRANCES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FLORENTINE
Middle Name:FRANCES
Last Name:WILK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-0747
Mailing Address - Country:US
Mailing Address - Phone:847-931-9455
Mailing Address - Fax:
Practice Address - Street 1:75 MARKET ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5093
Practice Address - Country:US
Practice Address - Phone:847-931-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004951103TC0700X
IL041104199163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health