Provider Demographics
NPI:1730812595
Name:WILSON, SEAYON
Entity type:Individual
Prefix:
First Name:SEAYON
Middle Name:
Last Name:WILSON
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 1:1790 NATIONS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9175
Mailing Address - Country:US
Mailing Address - Phone:618-792-2284
Mailing Address - Fax:
Practice Address - Street 1:1790 NATIONS DR STE 110
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9175
Practice Address - Country:US
Practice Address - Phone:618-792-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health