Provider Demographics
NPI:1265194930
Name:WREN, JAMES ERIC IV (MS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ERIC
Last Name:WREN
Suffix:IV
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 N SEMINARY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4396
Mailing Address - Country:US
Mailing Address - Phone:254-715-1866
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST STE 1015
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1710
Practice Address - Country:US
Practice Address - Phone:254-715-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000927106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist