Provider Demographics
NPI:1063712180
Name:WALL, DARCY (APSW)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:
Other - Last Name:LINDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:WI
Mailing Address - Zip Code:54411-9503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4636
Practice Address - Country:US
Practice Address - Phone:800-246-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2023-10-02
Deactivation Date:2023-08-24
Deactivation Code:
Reactivation Date:2023-10-02
Provider Licenses
StateLicense IDTaxonomies
WI134507-121104100000X
WI4681-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant