1427462191 NPI number — WIRTH COUNSELING SERVICES, P.C.

Table of content: MRS. DIANE LYNN DUNNIWAY NPP (NPI 1104986330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427462191 NPI number — WIRTH COUNSELING SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WIRTH COUNSELING SERVICES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427462191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 LENOX ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW LENOX
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60451-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-717-8575
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19250 EVERETT LN
Provider Second Line Business Practice Location Address:
SUITE #102
Provider Business Practice Location Address City Name:
MOKENA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60448-8942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-925-7258
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WIRTH
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-925-7258

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180009160 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1932512902 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com