Individual
DR. IRENA M WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
9245 CALUMET AVE, SUITE 201C, MUNSTER, IN 46321
(219) 836-0966
(773) 561-9266
Mailing address
2245 W WINNEMAC AVE, CHICAGO, IL 60625-1815
(773) 561-9773
(773) 561-9266
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20040333
IN
103T00000X
Psychologist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017597
VALUE OPTIONS
—
01
—
31604340
BCBS OF IL
IL
Enumeration date
01/11/2007
Last updated
07/08/2007
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