Individual
BRIANNA WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1307 W MAIN ST, MARION, IL 62959-1139
(618) 997-5336
(618) 993-2969
Mailing address
500 BARNETT AVE APT B, CARTERVILLE, IL 62918-5099
(618) 435-7893
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/24/2011
Last updated
10/24/2011
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