DR. ROBERT SCOTT WALLER (NPI# 1174014625) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174014625 |
| Entity Type | Individual |
| Full Name | DR. ROBERT SCOTT WALLER |
| Credential | PSYD |
| Practice Address |
1276 N Clybourn Ave Chicago IL 60610 |
| Mailing Address |
1441 W Elmdale Ave Apt 1s Chicago IL 60660-2405 |
| Practice Telephone | 3123371073 |
| Mailing Telephone | 2392487437 |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2019-07-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
071009689 | IL | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
071009689 | IL | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1525 E 53rd St Ste 623, Chicago, IL 606154530 | 2392487437 | |
| 30 N Michigan Ave Ste 529, Chicago, IL 606023491 | 3126295075 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831494525 | Robert Waller | Specialist/Technologist | 10651 Wilshire Ave Ne, Albuquerque, NM 87122-3160 | 2011-01-11 |
| 1699267872 | Robert Andrew Waller Jr. | Student in an Organized Health Care Education/Training Program | 500 University Dr, Hershey, PA 17033-2360 | 2018-06-04 |
| 1760543508 | Robert Ray Waller | Psychologist | 2500 S Broadway, Building 200, Edmond, OK 73013-4038 | 2006-12-13 |
| 1326097809 | Robert C Waller | Emergency Medicine | 75 Sheldon Blvd Se, Grand Rapids, MI 49503-4224 | 2006-05-10 |
| Street Address |
1276 N CLYBOURN AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60610 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821079088 | Near North Health Service Corporation | Clinic/Center | 1276 N Clybourn Ave, Chicago, IL 60610-2089 | 2005-11-07 |
| 1821695487 | Ada Yanci Lemus I | Nurse Practitioner | 1276 N Clybourn Ave, Chicago, IL 60610-2089 | 2020-10-07 |
| 1578127684 | Gerald Santangelo | Nurse Practitioner | 1276 N Clybourn Ave, Chicago, IL 60610-2003 | 2019-04-24 |
| 1326514365 | Near North Health Service Corporation | Case Management | 1276 N Clybourn Ave, Chicago, IL 60610-2003 | 2018-10-17 |
| 1720563695 | Angie Oliver | Nurse Practitioner | 1276 N Clybourn Ave, Chicago, IL 60610-2089 | 2018-09-26 |
| 1013499839 | Andrew Koch | Nurse Practitioner | 1276 N Clybourn Ave, Chicago, IL 60610 | 2018-08-29 |
| 1992284889 | Shaina Herring | Midwife | 1276 N Clybourn Ave, Chicago, IL 60610-2089 | 2018-08-10 |
| 1164909412 | Sarah Kehinde Nkwocha | Nurse Practitioner | 1276 N Clybourn Ave, Chicago, IL 60610 | 2018-07-19 |
| 1558864561 | Cynthia L Tran | Nurse Practitioner | 1276 N Clybourn Ave, Chicago, IL 60610-2089 | 2018-03-15 |
| 1326540782 | Celeste Mcfarland | Nurse Practitioner | 1276 N Clybourn Ave, Chicago, IL 60610-2089 | 2018-03-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326683145 | Roslyn M Jordan | Counselor | 860 N. Lasalle, Chicago, IL 60610 | 2019-11-15 |
| 1992278196 | Deangela Roberson | Specialist/Technologist, Other | 1212 N. Lasalle, Ste 100/ Surgery Center, Chicago, IL 60610 | 2019-01-10 |
| 1477053205 | Terri Lynn Tyson | Counselor | 1250 N. Dearborn St., 18b, Chicago, IL 60610 | 2018-02-19 |
| 1487153797 | Jennifer Quinn | Social Worker | 1200 N. Lasalle Street, Chicago, IL 60610 | 2018-02-02 |
| 1811415334 | Erin Conroy | Behavioral Analyst | 1400 North Lake Shore Drive Apt 8a, Chicago, IL 60610 | 2017-09-05 |
| 1659898674 | Courtney Jane Busing | Speech-Language Pathologist | 1211 N Lasalle, 903, Chicago, IL 60610 | 2017-08-30 |
| 1528503042 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 908 North State Street, Chicago, IL 60610 | 2016-12-20 |
| 1548702814 | Melissa Snyder | Counselor | 1820 N Lasalle Blvd, Counseling- Sweeting, Chicago, IL 60610 | 2016-11-17 |
| 1982146908 | Samantha Ruth Slagh | Physical Therapist | 1100 N Lasalle Street, Apt 1018, Chicago, IL 60610 | 2016-11-08 |
| 1891242426 | Stephanie Pinsler | Counselor | 100 W Chestnut, #1907, Chicago, IL 60610 | 2016-09-01 |
| Find all providers in zip 60610 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821699166 | Jennifer Knuepfer, Psyd, Pllc | Psychologist | 4256 N Ravenswood Ave Ste 305, Chicago, IL 60613-1114 | 2020-11-03 |
| 1104426170 | Grace Giedgowd | Psychologist | 1640 W Division St Apt 205, Chicago, IL 60622-3939 | 2020-10-29 |
| 1184223364 | Caroline Elisabeth Fulton | Psychologist | 1739 N Elston Ave, Chicago, IL 60642-1544 | 2020-10-20 |
| 1881293108 | Haley Michelle Sims | Psychologist | 65 E Wacker Pl Ste 300, Chicago, IL 60601-7203 | 2020-10-19 |
| 1285231936 | Qianhui Zhang | Psychologist | 1225 W Morse Ave Apt 403, Chicago, IL 60626-5751 | 2020-10-06 |
| 1316544158 | Nancy Marie Picard | Psychologist | 4885 N Hermitage Ave, Chicago, IL 60640-4104 | 2020-10-05 |
| 1730792151 | Jenny Marie Wamsat | Psychologist | 1921 W Diversey Pkwy Apt 402, Chicago, IL 60614-9412 | 2020-08-25 |
| 1497365910 | Sara Sirota | Psychologist | 5443 N Broadway St # 2s, Chicago, IL 60640-1703 | 2020-08-10 |
| 1053920512 | Alyse Renae Bedell | Psychologist | 5841 S Maryland Ave Ste 300, Chicago, IL 60637-1443 | 2020-07-30 |
| 1699392688 | Hongying Chen | Psychologist | 720 W Sheridan Rd Apt 3s, Chicago, IL 60613-3252 | 2020-06-25 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.