Benjamin Nishan Wall
Social Worker, Clinical in Waukegan, IL. Individual provider (NPI-1).
NPI number1669200093
StatusActive
Last updated in NPPESJul 25, 2024
Details
- NPI
- 1669200093
- Entity type
- Individual (NPI-1)
- Name
- Benjamin Nishan Wall
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 25, 2024
- Certification date
- Jul 25, 2024
- Last updated
- Jul 25, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | – | – | Yes |
Practice location
415 Washington St Ste 200Waukegan, IL 60085-5564
Phone 847-441-5600
Mailing address
3657 N Whipple St Apt 1fChicago, IL 60618-4519
Phone 559-799-1139
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