(800) 868-1923

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: