Fiona Christine Waller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2022029180 Issued in MO

Practice address

145 Morris LN Unit 108
Lake Forest, IL 60045-1389

Phone

(630) 596-7359

NPI assigned

May 26, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1710552203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 MORRIS LN UNIT 108",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451389",
            "telephone_number": "630-596-7359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MORRIS LN UNIT 108",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451389",
            "telephone_number": "630-596-7359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "FIONA",
        "middle_name": "CHRISTINE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-26",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2020013516",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2022029180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOCIAL WORK LICENSE",
            "identifier": "2020013516",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW",
            "identifier": "2022029180",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna Wagner, CCC-SLP
• Edye Lynn Wagner, RD, LDN
• Walgreen Co
• Walgreen Co
• Linda A. Walker, L.M.T.
• Anuja Thakkar Walsh, D.O.
• Michael Thomas Walsh, MD
• David D Wang, MD PHD
• Elizabeth Q Wang, CPNP
• Ryan S Wang, MD

• Clinical Social Worker in Lake Forest, IL
• Providers in Lake Forest, 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 Jan 23, 2024; 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.