Provider Demographics
NPI:1336918457
Name:WALKER, WESLEY HARRISON (LSW)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:HARRISON
Last Name:WALKER
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 W 48TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-4432
Mailing Address - Country:US
Mailing Address - Phone:815-404-1432
Mailing Address - Fax:
Practice Address - Street 1:2043 W BELMONT AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6796
Practice Address - Country:US
Practice Address - Phone:224-326-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.111451104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker