Heidi Allison Wilken Wallace, LCSW
Individual provider Active NPI Clinical Social Worker · Walnut, IL
NPI 1528107471 · NPPES record last updated Nov 19, 2012
Key facts
- NPI
- 1528107471
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149012947 (IL)
- Practice address
- 27566 1375 East St
Walnut, IL 61376-9528 - Phone
- (815) 383-7277
- Fax
- (815) 379-2184
- NPI assigned
- Feb 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 149012947 | IL | MD | Clinical Social Worker |
| HW49060306P | IL | MD | Developmental Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149012947 | IL | Yes |
| Developmental Therapist | 222Q00000X | HW49060306P | IL |
Addresses
Primary practice location
27566 1375 East St
Walnut, IL 61376-9528
Mailing address
27566 1375 East St
Walnut, IL 61376-9528
Phone (815) 383-7277
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HW49060306P | Other | IL | EARLY INTERVENTION |
Other names
- Heidi Allison Wilken
Other providers in Walnut, IL
- Colton Ronald Johnson
- Julia Rackley Perry Memorial Hospital
- Julia Rackley Perry Memorial Hospital
- Aspen Quadri
- Kelly Cotaleen Todd
- Walnut Fire Department Inc
- Walnut Fire Protection District
All providers in Walnut, IL · Clinical Social Worker 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 19, 2012. 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.