Provider Demographics
NPI:1740085612
Name:WILKINS, WALTER
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:WILKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 MOON LAKE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1070
Mailing Address - Country:US
Mailing Address - Phone:312-965-2997
Mailing Address - Fax:312-929-0324
Practice Address - Street 1:1721 MOON LAKE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1070
Practice Address - Country:US
Practice Address - Phone:312-965-2997
Practice Address - Fax:312-929-0324
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician