Individual
MISS DARLENE J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1701 E WOODFIELD RD, SUITE 321, SCHAUMBURG, IL 60173
(773) 775-0097
(847) 413-0429
Mailing address
6800 N WAUKESHA AVE, CHICAGO, IL 60646-1528
(773) 775-0097
(847) 413-0429
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01671233
BLUE CROSS OF IL
IL
Enumeration date
01/22/2007
Last updated
07/08/2007
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