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NPI Code Detail

MEDICARE: ELIZABETH LOUISE FISK WALSH M.A., L.C.P.C.

MEDICARE:   ELIZABETH LOUISE FISK WALSH  M.A., L.C.P.C.
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
1101YM0800XMental Health CounselorIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17393766OTHERILAETNA PIN
201635454OTHERILBCBS PROVIDER NUMBER
3361350OTHERILMANAGED HEALTHCARE PIN

General Provider Information

NPI Number : 1871568584
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH LOUISE FISK WALSH M.A., L.C.P.C.
Provider Business Mailing Address
First Line : 30 N MICHIGAN AVE
Second Line : SUITE 1516
City : CHICAGO
State : IL
Zip : 60602-3402
Country : US
Telephone Number : 312-514-5689
Fax Number : 312-943-8721
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE
Second Line : SUITE 1516
City : CHICAGO
State : IL
Zip : 60602-3402
Country : US
Telephone Number : 312-514-5689
Fax Number : 312-943-8721
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 07/08/2007

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