Walter Fasken
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · La Salle, IL
NPI 1003538950 · NPPES record last updated Nov 4, 2022
Key facts
- NPI
- 1003538950
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 36350 (IL)
- Practice address
- 111 Bucklin St Ste 1
La Salle, IL 61301-2382 - Phone
- (815) 780-0690
- NPI assigned
- Sep 16, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36350 | IL | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 36350 | IL | Yes |
Addresses
Primary practice location
111 Bucklin St Ste 1
La Salle, IL 61301-2382
Mailing address
7648 S Oconto Ave
Bridgeview, IL 60455-1323
Phone (708) 979-1815
Other providers in La Salle, IL
- Dr Nicholas M Tabor III DPM
- Dr William White PC
- Karen R. Dunne
- Christine Eimer
- Diane Louise Farrell
- Kara O Fess
- Morgan Filippini
- Kimberly Forristall
- Christine M Frost
- Shelly Garncarz
All providers in La Salle, IL · Addiction (Substance Use Disorder) Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.