Provider Demographics
NPI:1427564947
Name:WALDER, DEBORA ESTER (BA)
Entity Type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:ESTER
Last Name:WALDER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:DEBORA
Other - Middle Name:ESTHER
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:6809 SO.CARPENTER
Mailing Address - Street 2:6535 SO.KEDZIE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621
Mailing Address - Country:US
Mailing Address - Phone:773-550-0131
Mailing Address - Fax:773-778-0018
Practice Address - Street 1:6809 S CARPENTER ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1131
Practice Address - Country:US
Practice Address - Phone:773-550-0131
Practice Address - Fax:773-778-0018
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL103442936OtherCIGNA NETWORK