Individual
NANETTE L WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CCFC
Contact information
Practice address
1011 HONOR HEIGHTS DR, MUSKOGEE, OK 74401-1318
(918) 683-3261
Mailing address
6351 W 22ND ST N, MUSKOGEE, OK 74401-1031
(918) 360-8275
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1760
SD
Other
Enumeration date
07/26/2006
Last updated
04/17/2020
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