| Doctor Name: | DORIS A WALLENBURG |
| NPI Number: | 1902109994 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 007232 |
| Business Practice Address: | 1505 20th St Rock Valley, IA - 512471040 |
| Business Phone Number: | 7125413836 |
| Business Fax Number: | 7127079220 |
| Mailing Address: | 1505 20th St, ROCK VALLEY |
| State: | IA |
| Postal Code: | 512471040 |
| Phone Number: | 7125413836 |
| Fax Number: | 7127079220 |
| NPI Enumeration Date: | 12/13/2010 |
| NPI Last Update Date: | 12/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 007232 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |