Healthcare Provider Details

I. General information

NPI: 1497590798
Provider Name (Legal Business Name): NATALIE I COLOMBANA WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE I WALSH

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 S NAPERVILLE RD STE HINSDALE
WHEATON IL
60189-5894
US

IV. Provider business mailing address

1039 COLLEGE AVE APT 1E
WHEATON IL
60187-5770
US

V. Phone/Fax

Practice location:
  • Phone: 630-325-5300
  • Fax:
Mailing address:
  • Phone: 650-452-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: