Provider Demographics
NPI:1740006303
Name:WALSH, CAITLIN RAY (LPC)
Entity type:Individual
Prefix:MISS
First Name:CAITLIN
Middle Name:RAY
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2827 VINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-2656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:815-298-8769
Practice Address - Street 1:6392 LINDEN RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-2816
Practice Address - Country:US
Practice Address - Phone:779-368-0060
Practice Address - Fax:833-972-0736
Is Sole Proprietor?:No
Enumeration Date:2024-11-28
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional