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NPI Code Detail

MEDICARE: KELLY WALLER

MEDICARE: KELLY WALLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041S0200XSchool Social Worker

General Provider Information

NPI Number : 1538537105
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY WALLER
Provider Business Mailing Address
First Line : 525 ROBERTS ST
Second Line :
City : RENO
State : NV
Zip : 89502-7818
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 525 ROBERTS ST
Second Line :
City : RENO
State : NV
Zip : 89502-7818
Country : US
Telephone Number : 775-348-8811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2015
Last Update Date : 09/12/2015

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Directions to “ KELLY WALLER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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