Provider Demographics
NPI:1326735267
Name:WALDER, ELIZABETH (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WALDER
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34214 N 1850 EAST RD
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60963-7041
Mailing Address - Country:US
Mailing Address - Phone:217-274-8214
Mailing Address - Fax:
Practice Address - Street 1:34214 N 1850 EAST RD
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60963-7041
Practice Address - Country:US
Practice Address - Phone:217-274-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker