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General NPI Number Information
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NPI Number | 1679046510
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Entity Type | Organization
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Legal Business Name | CYNTHIA WALLS, PC
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD STE 626
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City | CHICAGO
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State | IL
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Zip | 60604-3444
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Country | US
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Telephone | 773-469-6299
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Fax |
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Provider Business Mailing Address
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Address Line | 3828 N CLAREMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60618-3818
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Country | US
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Telephone | 773-469-6299
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CYNTHIA WALLS
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Credential | PC
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Telephone | 773-469-6299
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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 |
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License Number State |
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