Healthcare Provider Details

I. General information

NPI: 1548454523
Provider Name (Legal Business Name): KAREN LORI BUCKWALTER L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S 24TH ST
QUINCY IL
62301-4446
US

IV. Provider business mailing address

205 S 24TH ST
QUINCY IL
62301-4446
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-0034
  • Fax: 217-222-3865
Mailing address:
  • Phone: 217-222-0034
  • Fax: 217-222-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: