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General NPI Number Information
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NPI Number | 1275244741
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Entity Type | Individual
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Provider Name | AUSTIN WADE HOWALD LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 212 S HERSHEY RD
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4524
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Country | US
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Telephone | 309-270-2728
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Fax |
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Provider Business Mailing Address
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Address Line | 8420 N KNOXVILLE AVE SUITE C #1099
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City | PEORIA
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State | IL
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Zip | 61615-4524
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Country | US
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Telephone | 309-270-2728
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.109801
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.028221
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License Number State | IL
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