MEDICARE: MS. SYDNEY L WALDEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	05142	IA

General Provider Information

NPI Number	:	1114257425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SYDNEY L WALDEN LCSW

Provider Business Mailing Address
First Line	:	410 S MICHIGAN AVE STE 928
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1399
Country	:	US
Telephone Number	:	312-248-3190
Fax Number	:	312-764-7632

Provider Business Practice Location Address
First Line	:	410 S MICHIGAN AVE STE 928
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1399
Country	:	US
Telephone Number	:	312-248-3190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2010
Last Update Date	:	06/28/2021

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