Search › Illinois › 103TS0200X
Jordan Wiles, SSP, NCSP
NPI 1770095119 · on the registry since 2017 · sole proprietor
Practice
- Address
- 807 N Mattis Ave
Champaign, IL 61821 - Phone
- (618) 919-0408
- Fax
- (618) 919-0408
- Clinicians at this address
- 3
Registry record
- Primary taxonomy
- 103TS0200X
103TS0200X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2017-10-25
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois