Provider Demographics
NPI:1659685154
Name:WALDER, CARLY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:
Last Name:WALDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 SKOKIE BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4019
Mailing Address - Country:US
Mailing Address - Phone:847-559-3240
Mailing Address - Fax:
Practice Address - Street 1:899 SKOKIE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4019
Practice Address - Country:US
Practice Address - Phone:847-559-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009161103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist