Provider Demographics
NPI:1639436991
Name:NANCY PETERSON WALZ, LCSW, P.C.
Entity Type:Organization
Organization Name:NANCY PETERSON WALZ, LCSW, P.C.
Other - Org Name:NPW COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ LICENSED CLINICAL SOCIAL WOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON WALZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-382-7029
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-0742
Mailing Address - Country:US
Mailing Address - Phone:815-382-7029
Mailing Address - Fax:
Practice Address - Street 1:7115 VIRGINIA RD
Practice Address - Street 2:SUITE 109
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3112
Practice Address - Country:US
Practice Address - Phone:815-382-7029
Practice Address - Fax:815-363-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490056371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207844Medicare PIN