Provider Demographics
NPI:1932325701
Name:WRIGHT, M JOANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:M JOANN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 OAKWOOD DR
Mailing Address - Street 2:#1J
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3084
Mailing Address - Country:US
Mailing Address - Phone:516-971-1217
Mailing Address - Fax:815-722-4384
Practice Address - Street 1:62 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-4331
Practice Address - Country:US
Practice Address - Phone:815-722-4384
Practice Address - Fax:815-722-4390
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9051Medicaid