Provider Demographics
NPI:1033377320
Name:WALSH, JODI KAY (MA LCPC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:KAY
Last Name:WALSH
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15915 S CRYSTAL CREEK DR
Mailing Address - Street 2:UNIT E
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9284
Mailing Address - Country:US
Mailing Address - Phone:708-334-7711
Mailing Address - Fax:
Practice Address - Street 1:15915 S CRYSTAL CREEK DRIVE
Practice Address - Street 2:UNIT E
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9284
Practice Address - Country:US
Practice Address - Phone:708-334-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional