Provider Demographics
NPI:1689984205
Name:WALSHE, MARY M (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:WALSHE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JORIE BLVD
Mailing Address - Street 2:#48
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2214
Mailing Address - Country:US
Mailing Address - Phone:630-368-9100
Mailing Address - Fax:
Practice Address - Street 1:1000 JORIE BLVD
Practice Address - Street 2:#48
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2214
Practice Address - Country:US
Practice Address - Phone:630-368-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149 - 004358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health