=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164645453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALDNER AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 07/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 65TH STREET
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60516-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-852-8873
-----------------------------------------------------
Fax | 630-852-8873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 65TH STREET
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60516-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-852-8873
-----------------------------------------------------
Fax | 630-852-8873
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. MARLENE A WALDNER
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 630-852-8873
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 180000290
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 180 004023
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------