Provider Demographics
NPI:1073942538
Name:WALLEN, JO ANNE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JO ANNE
Middle Name:
Last Name:WALLEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MERION AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2324
Mailing Address - Country:US
Mailing Address - Phone:610-256-1949
Mailing Address - Fax:
Practice Address - Street 1:321 MERION AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2324
Practice Address - Country:US
Practice Address - Phone:610-256-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000610L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical