Provider Demographics
NPI:1467819656
Name:WALSH, CLAIRE (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 S WABASH AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2898
Mailing Address - Country:US
Mailing Address - Phone:708-308-1750
Mailing Address - Fax:
Practice Address - Street 1:634 BROOKLYN DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9038
Practice Address - Country:US
Practice Address - Phone:630-800-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist