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General NPI Number Information
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NPI Number | 1831476985
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Entity Type | Individual
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Provider Name | DARAH ELAINE WALLSTEN PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 636 CHURCH ST STE 405
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City | EVANSTON
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State | IL
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Zip | 60201-4580
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Country | US
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Telephone | 847-250-9959
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Fax | 847-306-8118
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Provider Business Mailing Address
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Address Line | 16-566 KEAAU PAHOA RD # 614
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City | KEAAU
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State | HI
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Zip | 96749-8137
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Country | US
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Telephone | 808-756-5030
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.021040
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4156
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4187
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License Number State | NC
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