Most Relevant Information
Provider Data
| NPI Number: | 1003538950 |
| Provider Name: | WALTER FASKEN |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 36350 |
Most Important Dates
| Enumeration Date: | 09/16/2022 |
| Last Updated: | 11/04/2022 |
Provider Practice Location
111 BUCKLIN ST STE 1
LA SALLE
IL
613012382
Practice Location Phone/Fax
| Phone: | 8157800690 |
| Fax: |
Provider Mailing Location
7648 S OCONTO AVE
BRIDGEVIEW
IL
604551323
Provider Mailing Phone/Fax
| Phone: | 7089791815 |
| Fax: |