Provider Demographics
NPI:1518406412
Name:WILDT, HILLARY (PSYD, LCP)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:WILDT
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10522 S CICERO AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5200
Mailing Address - Country:US
Mailing Address - Phone:773-270-2150
Mailing Address - Fax:
Practice Address - Street 1:10522 S CICERO AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5200
Practice Address - Country:US
Practice Address - Phone:773-270-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009493103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical