Active NPI
Elizabeth Janiece Wilson, PHD
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1871322917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20043799B
- Practice address
- 1645 W Jackson Blvd Ste 400
Chicago, IL 60612-3244 - Phone
- (312) 563-9636
- NPI assigned
- Jul 29, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20043799B | IN | Primary |
Addresses
Primary practice location
1645 W Jackson Blvd Ste 400
Chicago, IL 60612-3244
Mailing address
1645 W Jackson Blvd
Chicago, IL 60612-3276
Phone (312) 563-9636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20043799B | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722211200000",
"number": "1871322917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1645 W JACKSON BLVD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123276",
"telephone_number": "312-563-9636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1645 W JACKSON BLVD STE 400",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123244",
"telephone_number": "312-563-9636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ELIZABETH",
"middle_name": "JANIECE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-29",
"last_updated": "2024-07-29",
"certification_date": "2024-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20043799B",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.