Individual
FIONA CHRISTINE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
145 MORRIS LN UNIT 108, LAKE FOREST, IL 60045-1389
(630) 596-7359
Mailing address
145 MORRIS LN UNIT 108, LAKE FOREST, IL 60045-1389
(630) 596-7359
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2020013516
MO
1041C0700X
Clinical Social Worker
Primary
2022029180
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020013516
SOCIAL WORK LICENSE
MO
01
—
2022029180
LCSW
MO
Enumeration date
05/26/2021
Last updated
01/23/2024
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