Provider Demographics
NPI:1609147628
Name:WALSH, KATHLEEN M (MA,LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:WALSH
Suffix:
Gender:F
Credentials:MA,LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N MICHIGAN AV
Mailing Address - Street 2:#523
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-729-5310
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AV
Practice Address - Street 2:#523
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-729-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0036581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical