Provider Demographics
NPI:1922186881
Name:WALK, TRUDY L (MA)
Entity Type:Individual
Prefix:MS
First Name:TRUDY
Middle Name:L
Last Name:WALK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 W ROOSEVELT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2331
Mailing Address - Country:US
Mailing Address - Phone:630-653-5540
Mailing Address - Fax:630-653-5542
Practice Address - Street 1:520 W ROOSEVELT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2331
Practice Address - Country:US
Practice Address - Phone:630-653-5540
Practice Address - Fax:630-653-5542
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist