Provider Demographics
NPI:1598949778
Name:FERGUSON-WALSH, CAROLINE E
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:E
Last Name:FERGUSON-WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5742 W AINSLIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2018
Mailing Address - Country:US
Mailing Address - Phone:773-683-2658
Mailing Address - Fax:
Practice Address - Street 1:5742 W AINSLIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2018
Practice Address - Country:US
Practice Address - Phone:773-683-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE 4227235Z00000X
IL146010391235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist