Robert Scott Waller, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071009689 Issued in IL

Practice address

1276 N Clybourn Ave
Chicago, IL 60610

Phone

(312) 337-1073

NPI assigned

May 21, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Springpsych Services LLC

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1295226736

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1174014625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 W ELMDALE AVE APT 1S",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606602405",
            "telephone_number": "239-248-7437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1276 N CLYBOURN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60610",
            "telephone_number": "312-337-1073"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1525 E 53rd St Ste 623",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606154530",
            "country_code": "US",
            "telephone_number": "239-248-7437",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 N Michigan Ave Ste 529",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606023491",
            "country_code": "US",
            "telephone_number": "312-629-5075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "ROBERT",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-21",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "071009689",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071009689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chelsea Lynn Wallaert, OTD OTR/L
• Sarah E Wallens, M.A.
• Adrian Waller
• Annika May Waller
• Kimberly Michelle Waller, LPN
• Sierra Waller
• Thomas Waller
• William Nathan Waller, CCC-SLP
• Derrick D Wallery, D.C.
• Amisha Wallia, MD

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.