Individual
ERIC LEE NELSON WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
11 S DIVISION ST, BONNE TERRE, MO 63628-1772
(573) 723-1100
Mailing address
722 JANEY DR, FARMINGTON, MO 63640-9209
(573) 760-5520
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2020009792
MO
Other
Enumeration date
04/03/2020
Last updated
04/03/2020
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