SUSAN P. WALLER

BLOOMINGTON, IL
NPI1821129958
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: IL  25608)
Enumeration Date2007-03-08
Last Update Date2007-07-08
Business Address
-- SUSAN P. WALLER CADC
702 W CHESTNUT ST
BLOOMINGTON, IL 61701-2814
Phone number: 309-827-6026
Mailing Address
-- SUSAN P. WALLER CADC
702 W CHESTNUT ST
BLOOMINGTON, IL 61701-2814
Phone number: 309-827-6026
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