Annette Marie Wilson, M.A.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071010159 Issued in IL

Practice address

5207 Main St
Downers Grove, IL 60515-4652

Phone

(815) 942-6323

Fax

(779) 210-5541

NPI assigned

Feb 23, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Doctor of Philosophy

State licenses

Interoperability endpoints

• Direct secure messaging: awilson205905@direct.edward.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1497995906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7410264",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606740264",
            "telephone_number": "815-942-6323",
            "fax_number": "779-210-5541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5207 MAIN ST",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605154652",
            "telephone_number": "815-942-6323",
            "fax_number": "779-210-5541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ANNETTE",
        "middle_name": "MARIE",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-23",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15711-130",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awilson205905@direct.edward.org",
            "affiliation": "N",
            "address_1": "5207 Main St",
            "city": "Downers Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605154652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kirsten Camille Williams, LCSW
• Lisa D Williams, RDH
• Susan Willoughby, APN CNM
• Willow Tree Mental Wellness PLLC
• Willowbrook Clinic
• Jonathan Paul Wilson, PHD, CCC-SLP
• Laura J Wilson, RDH
• Michael Wince, DDS
• Melissa L Wingo, PA-C
• Wingspan Therapy, PLLC

• Clinical Psychologist in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.