Provider Demographics
NPI:1720624653
Name:WALSH, JENNIFER ROSE LEAMY
Entity Type:Individual
Prefix:
First Name:JENNIFER ROSE
Middle Name:LEAMY
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16115 LOREL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3836
Mailing Address - Country:US
Mailing Address - Phone:708-897-7788
Mailing Address - Fax:
Practice Address - Street 1:16115 LOREL AVE
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3836
Practice Address - Country:US
Practice Address - Phone:708-897-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty