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General NPI Number Information
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NPI Number | 1366035701
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Entity Type | Individual
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Provider Name | MONICA WALA
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Gender | Female
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 5501 S 1100 W
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City | WESTVILLE
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State | IN
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Zip | 46391-9335
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Country | US
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Telephone | 219-785-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 4657 N CANFIELD AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-4414
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Country | US
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Telephone | 773-575-5841
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20043188A
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License Number State | IN
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