Provider Demographics
NPI:1356539316
Name:WIMAN, JODI L (MA)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:L
Last Name:WIMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 W MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OBLONG
Mailing Address - State:IL
Mailing Address - Zip Code:62449-1165
Mailing Address - Country:US
Mailing Address - Phone:618-592-3116
Mailing Address - Fax:618-592-3117
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:OBLONG
Practice Address - State:IL
Practice Address - Zip Code:62449-1165
Practice Address - Country:US
Practice Address - Phone:618-592-3116
Practice Address - Fax:618-592-3117
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006960101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional