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General NPI Number Information
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NPI Number | 1780756775
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Entity Type | Individual
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Provider Name | SHERRY CHEMOKE WALLER LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 110 W K ST
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City | SHELTON
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State | WA
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Zip | 98584-2939
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Country | US
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Telephone | 360-426-1696
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Fax | 360-427-0357
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Provider Business Mailing Address
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Address Line | 3857 MARTIN WAY E
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City | OLYMPIA
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State | WA
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Zip | 98506-5268
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Country | US
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Telephone | 360-704-7170
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Fax | 360-709-4374
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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 | LW00006542
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License Number State | WA
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