Healthcare Provider Details

I. General information

NPI: 1326815739
Provider Name (Legal Business Name): DANI WALSH THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 OAK ST
WINNETKA IL
60093-2423
US

IV. Provider business mailing address

1001 GREEN BAY RD UNIT 124
WINNETKA IL
60093-1721
US

V. Phone/Fax

Practice location:
  • Phone: 617-947-0079
  • Fax:
Mailing address:
  • Phone: 617-947-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE WALSH
Title or Position: OWNER
Credential: LCSW
Phone: 617-947-0079