Diana L Wall- Dudley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.009947 Issued in IL

Practice address

2014 Vandalia St
Collinsville, IL 62234-4848

Phone

(618) 345-9536

Fax

(618) 345-9587

NPI assigned

Nov 5, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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.

• Family Life Consultants, Inc

  • Psychologist
  • Collinsville, IL
  • NPI 1164532248
  NPD (past)

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393200000000",
    "number": "1386998938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2014 VANDALIA ST",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622344848",
            "telephone_number": "618-345-9536",
            "fax_number": "618-345-9587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2014 VANDALIA ST",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622344848",
            "telephone_number": "618-345-9536",
            "fax_number": "618-345-9587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL- DUDLEY",
        "first_name": "DIANA",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-05",
        "last_updated": "2014-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.009947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Renee Walden, M.S., CCC-SLP/L
• Walgreen Co (Walgreens #02490)
• Walgreen Co. (Walgreens #09750)
• Walgreen Co. (Walgreens #9750)
• Jessica Lynn Walker, FNP-BC
• Kimberly D Wallace, SLP
• Walmart Inc
• Walmart Inc.
• Kimberly A Washburn, MSW
• Beverley Banks Watkins, PH.D.

• Clinical Social Worker in Collinsville, IL
• Providers in Collinsville, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2014; 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.