Provider Demographics
NPI:1659166312
Name:WILHELM, MACY JO
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:JO
Last Name:WILHELM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:52069-0155
Mailing Address - Country:US
Mailing Address - Phone:563-209-5841
Mailing Address - Fax:
Practice Address - Street 1:3601 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-2363
Practice Address - Country:US
Practice Address - Phone:319-390-4611
Practice Address - Fax:319-390-4381
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)