Provider Demographics
NPI:1144359886
Name:WILSON, VALERIE L (MA)
Entity type:Individual
Prefix:MISS
First Name:VALERIE
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18085 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-2905
Mailing Address - Country:US
Mailing Address - Phone:773-297-8652
Mailing Address - Fax:708-798-1647
Practice Address - Street 1:18085 VISTA DR
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-2905
Practice Address - Country:US
Practice Address - Phone:773-297-8652
Practice Address - Fax:708-798-1647
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist