Provider Demographics
NPI:1891703757
Name:THORNTON, WYLENA NELL (MADT)
Entity Type:Individual
Prefix:MS
First Name:WYLENA
Middle Name:NELL
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14513 BENSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BURHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60633-2205
Mailing Address - Country:US
Mailing Address - Phone:708-730-3328
Mailing Address - Fax:708-730-0710
Practice Address - Street 1:14513 BENSLEY AVE
Practice Address - Street 2:
Practice Address - City:BURHAM
Practice Address - State:IL
Practice Address - Zip Code:60633-2205
Practice Address - Country:US
Practice Address - Phone:708-730-3328
Practice Address - Fax:708-730-0710
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist