Provider Demographics
NPI:1548385669
Name:WISE BURRELL, VALERIE D (LCSW)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:D
Last Name:WISE BURRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9245 CALUMET AVE
Mailing Address - Street 2:SUITE 101-A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2821
Mailing Address - Country:US
Mailing Address - Phone:708-269-8063
Mailing Address - Fax:219-810-6459
Practice Address - Street 1:9245 CALUMET AVE
Practice Address - Street 2:SUITE 101-A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2821
Practice Address - Country:US
Practice Address - Phone:708-269-8063
Practice Address - Fax:219-810-6459
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006621A1041C0700X
IL1490082101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical