Provider Demographics
NPI:1477891919
Name:WALSH, MEGAN K (LPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:K
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3S557 LORRAINE AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3227
Mailing Address - Country:US
Mailing Address - Phone:630-728-0957
Mailing Address - Fax:
Practice Address - Street 1:544 S CORNELL AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2948
Practice Address - Country:US
Practice Address - Phone:630-993-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.003709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional