Provider Demographics
NPI:1285828921
Name:WALSH, LAURIE (MSW, LCSW, MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MSW, LCSW, MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE STE 918
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3762
Mailing Address - Country:US
Mailing Address - Phone:312-933-5510
Mailing Address - Fax:312-372-3240
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 918
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-933-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000956171100000X
IL1490087701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171100000XOther Service ProvidersAcupuncturist