MEDICARE: LANAY DENIECE WALLS 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	21114	IL
2	101YM0800X	Mental Health Counselor	149.026493	IL
3	1041C0700X	Clinical Social Worker	149.026493	IL

General Provider Information

NPI Number	:	1710753835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANAY DENIECE WALLS LCSW

Provider Business Mailing Address
First Line	:	1200 E 78TH ST APT 205
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3372
Country	:	US
Telephone Number	:	312-998-9098
Fax Number	:	773-359-4521

Provider Business Practice Location Address
First Line	:	1200 E 78TH ST APT 205
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3372
Country	:	US
Telephone Number	:	773-485-9597
Fax Number	:	773-359-4521

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

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	03/10/2026

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