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General NPI Number Information
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NPI Number | 1073744140
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Entity Type | Individual
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Provider Name | WAYLAND BARBER SMITH L.C.S.W./C.A.D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 820 S DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3728
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Country | US
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Telephone | 312-569-7588
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 HIGHLAND AVE
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City | OAK PARK
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State | IL
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Zip | 60304-2210
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Country | US
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Telephone | 708-386-5282
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Fax | 773-854-1866
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.004102
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License Number State | IL
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