Individual
DIANE LOUISE WALLENDJACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EDD, NCSP
Contact information
Practice address
65 WOODSIDE RD, RIVERSIDE, IL 60546-1974
(708) 447-3896
Mailing address
65 WOODSIDE RD, RIVERSIDE, IL 60546-1974
(708) 447-3896
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
899294
IL
Other
Enumeration date
09/22/2017
Last updated
07/21/2022
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