Provider Demographics
NPI:1336359447
Name:WILKENING, PATRICIA JEAN (MSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JEAN
Last Name:WILKENING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-2142
Mailing Address - Country:US
Mailing Address - Phone:219-473-9026
Mailing Address - Fax:
Practice Address - Street 1:14419 S ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:IL
Practice Address - Zip Code:60827-2780
Practice Address - Country:US
Practice Address - Phone:708-841-0432
Practice Address - Fax:708-841-0153
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000311A1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool