| Wyellis Inc | |
|
1607 W Court St Kankakee IL 60901-3216 | |
| (815) 450-7100 | |
| (815) 401-5821 |
| Full Name | Wyellis Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1607 W Court St, Kankakee, Illinois |
| Authorized Official Name and Position | Alfreta Daniel (BILLING MANAGER) |
| Authorized Official Contact | 8154507100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wyellis Inc 1607 W Court St Kankakee IL 60901-3216 Ph: (815) 450-7100 | Wyellis Inc 1607 W Court St Kankakee IL 60901-3216 Ph: (815) 450-7100 |
| NPI Number | 1770117475 |
|---|---|
| Provider Enumeration Date | 03/03/2020 |
| Last Update Date | 03/03/2020 |
| Certification Date | 03/03/2020 |
| Medicare PECOS PAC ID | 6608206800 |
|---|---|
| Medicare Enrollment ID | O20200429002856 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770117475 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Debra L. Ciasulli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104082452 PECOS PAC ID: 2961638598 Enrollment ID: I20151124000645 |
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