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General NPI Number Information
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NPI Number | 1558635490
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Entity Type | Individual
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Provider Name | YOLANDA WALTERS
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Gender | Female
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 4118 GREENLEAF CT
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City | PARK CITY
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State | IL
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Zip | 60085-8509
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Country | US
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Telephone | 847-360-9788
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Fax | 847-360-9791
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Provider Business Mailing Address
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Address Line | 3010 GRAND AVE
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City | WAUKEGAN
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State | IL
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Zip | 60085-2321
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Country | US
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Telephone | 847-360-9788
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Fax | 847-360-9791
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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