Individual
DR. ROBERT SCOTT WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1276 N CLYBOURN AVE, CHICAGO, IL 60610
(312) 337-1073
Mailing address
1441 W ELMDALE AVE APT 1S, CHICAGO, IL 60660-2405
(239) 248-7437
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
071009689
IL
103TC0700X
Clinical Psychologist
Primary
071009689
IL
Other
Enumeration date
05/21/2018
Last updated
07/31/2019
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