Organization
SPRINGPSYCH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT SCOTT WALLER PSYD (OWNER, CLINICAL PSYCHOLOGIST)
(239) 248-7437
Entity
Organization
Contact information
Practice address
30 N MICHIGAN AVE STE 529, CHICAGO, IL 60602-3491
(312) 629-5075
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
08/08/2019
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