Provider Demographics
NPI:1154505170
Name:WALTERS, DALE MELIN (MS)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:MELIN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 APPLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1131
Mailing Address - Country:US
Mailing Address - Phone:847-935-5909
Mailing Address - Fax:
Practice Address - Street 1:4125 APPLEWOOD LN
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1131
Practice Address - Country:US
Practice Address - Phone:847-935-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional