Provider Demographics
NPI:1558635490
Name:WALTERS, YOLANDA
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2321
Mailing Address - Country:US
Mailing Address - Phone:847-360-9788
Mailing Address - Fax:847-360-9791
Practice Address - Street 1:4118 GREENLEAF CT
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:IL
Practice Address - Zip Code:60085-8509
Practice Address - Country:US
Practice Address - Phone:847-360-9788
Practice Address - Fax:847-360-9791
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health