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1770095119
JORDAN KENT WILES
CHAMPAIGN, IL
NPI
1770095119
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
103TS0200X Psychologist, School
Enumeration Date
2017-10-25
Last Update Date
2017-10-25
Business Address
Mr. JORDAN KENT WILES SSP, NCSP
807 N MATTIS AVE
CHAMPAIGN, IL 61821-2448
Phone number: 618-919-0408
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Mailing Address
Mr. JORDAN KENT WILES SSP, NCSP
807 N MATTIS AVE
CHAMPAIGN, IL 61821-2448
Phone number: 618-919-0408
Copy
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