Healthcare Provider Details

I. General information

NPI: 1285542043
Provider Name (Legal Business Name): MATTHEW WALSH LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 GRANT ST
EVANSTON IL
60201-2504
US

IV. Provider business mailing address

2220 GRANT ST
EVANSTON IL
60201-2504
US

V. Phone/Fax

Practice location:
  • Phone: 847-644-1653
  • Fax:
Mailing address:
  • Phone: 847-644-1653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.117774
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: