Provider Demographics
NPI:1710243035
Name:WAHLEN, LINDA (MSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WAHLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 N 129TH INFANTRY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3105
Mailing Address - Country:US
Mailing Address - Phone:815-823-8460
Mailing Address - Fax:815-823-8461
Practice Address - Street 1:822 N 129TH INFANTRY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3105
Practice Address - Country:US
Practice Address - Phone:815-823-8460
Practice Address - Fax:815-823-8461
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490078861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical