Provider Information for 1982431094
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Ms. EBONY WALLER LMFT, RPT, PHD
Sex: Female
NPI: 1982431094
Last Updated: 2024-09-14
Certification Date: 2024-09-14
Certification Date: 2024-09-14
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1982431094 | ||||||||
| Enumeration Date | 2024-09-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 7572 N CHERRYVALE BLVD APT 204 CHERRY VALLEY, IL 61016-9305 United States Phone: 702-572-8535 | Fax: | ||||||||
| Primary Practice Address | 7572 N CHERRYVALE BLVD APT 204 CHERRY VALLEY, IL 61016-9305 United States Phone: 702-572-8535 | Fax: | ||||||||
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