Individual
CASEY ANN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2845 N SHERIDAN RD, SUITE 809, CHICAGO, IL 60657
(312) 761-4721
Mailing address
3024 N LINCOLN AVE UNIT F, CHICAGO, IL 60657-4253
(269) 760-4020
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
149026886
IL
Other
Enumeration date
05/06/2021
Last updated
07/04/2024
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