| Doctor Name: | MS. EDITH WIRTZ |
| NPI Number: | 1023488640 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 178008236 |
| Business Practice Address: | 111 E Main St St Charles, IL - 601741948 |
| Business Phone Number: | 6305873777 |
| Business Fax Number: | |
| Mailing Address: | 113 Pheasant Trl, LAKE IN THE HILLS |
| State: | IL |
| Postal Code: | 601561240 |
| Phone Number: | 8477324591 |
| Fax Number: | |
| NPI Enumeration Date: | 09/26/2015 |
| NPI Last Update Date: | 09/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 178008236 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |