Individual
JACLYN WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6501 STANLEY AVE, BERWYN, IL 60402-3123
(708) 484-7400
Mailing address
5018 W 23RD ST, CICERO, IL 60804-2927
(334) 718-9025
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180.008708
IL
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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