Healthcare Provider Details

I. General information

NPI: 1568900835
Provider Name (Legal Business Name): JAMIKA WALTON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W LAKE ST
CHICAGO IL
60644-2342
US

IV. Provider business mailing address

4328 S FAIRFIELD AVE
CHICAGO IL
60632-1223
US

V. Phone/Fax

Practice location:
  • Phone: 708-378-3347
  • Fax: 773-378-4028
Mailing address:
  • Phone: 219-617-9162
  • Fax: 773-378-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33007957A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149020040
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: