Tywanda Jiles, MFT-IT,

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

1130-228 Issued in WI

Practice address

14540 S Marquette Ave
Burnham, IL 60633-2007

Phone

(737) 710-6897

NPI assigned

May 17, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beginners Depoot Ece Consulting

  • Early Intervention Provider Agency
  • Chicago, IL
  • NPI 1043592801
  NPD (past) Authorized official

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1992912703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14540 S MARQUETTE AVE",
            "city": "BURNHAM",
            "state": "IL",
            "postal_code": "606332007",
            "telephone_number": "773-710-6897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14540 S MARQUETTE AVE",
            "city": "BURNHAM",
            "state": "IL",
            "postal_code": "606332007",
            "telephone_number": "737-710-6897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JILES",
        "first_name": "TYWANDA",
        "name_prefix": "Dr.",
        "credential": "MFT-IT,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "1130-228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARRIGE AND FAMILY THERAPIST",
            "identifier": "1130-228",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latoya T Hall
• Kenon Harding
• Nehemiah-Ben Israel
• Phillip Jackson
• Stacy Jarrett, LSW
• Katisha Johnson
• Toya Elaine Johnson, LCSW
• Sharron Lynese McKee, LCSW
• Jiny M Moller, APRN
• Robin Moore, LCSW

• All providers in Burnham, IL
• Marriage & Family Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.