Healthcare Provider Details

I. General information

NPI: 1518876143
Provider Name (Legal Business Name): SCHRONA WALLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 TEACO RD
KENNETT MO
63857-3239
US

IV. Provider business mailing address

1005 COURT ST
KENNETT MO
63857-1401
US

V. Phone/Fax

Practice location:
  • Phone: 870-565-9776
  • Fax:
Mailing address:
  • Phone: 573-717-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: