1629087994 NPI number — MR. THOMAS JOSEPH WILDA SOCIAL WORK, MSW

Table of content: MR. THOMAS JOSEPH WILDA SOCIAL WORK, MSW (NPI 1629087994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629087994 NPI number — MR. THOMAS JOSEPH WILDA SOCIAL WORK, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILDA
Provider First Name:
THOMAS
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SOCIAL WORK, MSW
Provider Gender Code:
M

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:
1629087994
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
655 W IRVING PARK RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60613-3123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-528-8075
Provider Business Mailing Address Fax Number:
773-248-3638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 W IRVING PARK RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60613-3123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-528-8075
Provider Business Practice Location Address Fax Number:
773-248-3638
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , 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)





Copyright © 2007-2025 www.npivalidator.com