MEDICARE: YOLANDA WALTERS

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1558635490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA WALTERS

Provider Business Mailing Address
First Line	:	3010 GRAND AVE
Second Line	:
City	:	WAUKEGAN
State	:	IL
Zip	:	60085-2321
Country	:	US
Telephone Number	:	847-360-9788
Fax Number	:	847-360-9791

Provider Business Practice Location Address
First Line	:	4118 GREENLEAF CT
Second Line	:
City	:	PARK CITY
State	:	IL
Zip	:	60085-8509
Country	:	US
Telephone Number	:	847-360-9788
Fax Number	:	847-360-9791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/23/2012

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Directions to “ YOLANDA WALTERS ” Practice Location

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