Provider Demographics
NPI:1821241449
Name:WALDON, MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WALDON
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 1:874 GREEN BAY RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1805
Mailing Address - Country:US
Mailing Address - Phone:847-306-0268
Mailing Address - Fax:
Practice Address - Street 1:874 GREEN BAY RD
Practice Address - Street 2:SUITE 320
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1805
Practice Address - Country:US
Practice Address - Phone:847-306-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0130921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical