Provider Demographics
NPI:1922321132
Name:WILSON, ELENA MELANIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:MELANIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27W130 ROOSEVELT RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1643
Mailing Address - Country:US
Mailing Address - Phone:630-588-8490
Mailing Address - Fax:
Practice Address - Street 1:27W130 ROOSEVELT RD STE 203
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1643
Practice Address - Country:US
Practice Address - Phone:630-588-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0139121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical