Provider Demographics
NPI:1942420567
Name:WACASER, ABIGAIL DIANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:DIANE
Last Name:WACASER
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 1:325 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1624
Mailing Address - Country:US
Mailing Address - Phone:217-370-6103
Mailing Address - Fax:
Practice Address - Street 1:125 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1877
Practice Address - Country:US
Practice Address - Phone:217-479-4284
Practice Address - Fax:217-479-4326
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21446511041S0200X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical