Individual
NIKITA WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1339 N LOREL AVE, CHICAGO, IL 60651-1367
(773) 297-9410
Mailing address
1339 N LOREL AVE, CHICAGO, IL 60651-1367
(773) 297-9410
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
01/04/2017
Last updated
01/04/2017
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