Provider Demographics
NPI:1831703164
Name:WILMARTH, MAGGIE
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:WILMARTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 N JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:DAVIS JUNCTION
Mailing Address - State:IL
Mailing Address - Zip Code:61020-9779
Mailing Address - Country:US
Mailing Address - Phone:815-751-5609
Mailing Address - Fax:
Practice Address - Street 1:124 W 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-1449
Practice Address - Country:US
Practice Address - Phone:815-290-0829
Practice Address - Fax:888-491-2199
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist