Provider Demographics
NPI:1376652925
Name:WALLS, DEBORAH RENEE (SOCIAL WORKER - CLIN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RENEE
Last Name:WALLS
Suffix:
Gender:F
Credentials:SOCIAL WORKER - CLIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SWEETBRIAR AVE
Mailing Address - Street 2:
Mailing Address - City:NEW WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1156
Mailing Address - Country:US
Mailing Address - Phone:317-535-4149
Mailing Address - Fax:317-988-3243
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2501
Practice Address - Fax:317-988-3243
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005152A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical