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Individual

SUSAN D WALLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PLMHP, PCMSW, MSW

Contact information

Practice address
2101 S 42ND ST, OMAHA, NE 68105-2909
(402) 553-3000
Mailing address
5646 OHIO ST, OMAHA, NE 68104-4138
(408) 806-8156

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
11317
NE
104100000X
Social Worker
7196
NE

Other

Enumeration date
11/30/2006
Last updated
10/10/2018
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