Doctor Name: | MS. JULIET ANN RUSSOM WALDEN |
NPI Number: | 1154614634 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BS, AM, LSCW |
License Number: | 149.014305 |
Business Practice Address: | 13136 Western Ave Blue Island, IL - 604062423 |
Business Phone Number: | 7089745800 |
Business Fax Number: | |
Mailing Address: | 1945 W 22nd Pl, CHICAGO |
State: | IL |
Postal Code: | 606084205 |
Phone Number: | 7732476689 |
Fax Number: | |
NPI Enumeration Date: | 05/17/2011 |
NPI Last Update Date: | 06/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149.014305 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |