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Individual

SAMANTHA CHRISTINE WALSH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
420 PENNSYLVANIA AVE STE 101, GLEN ELLYN, IL 60137-4427
(630) 474-4353
Mailing address
420 PENNSYLVANIA AVE STE 101, GLEN ELLYN, IL 60137-4427
(630) 474-4353

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
221700000X
Art Therapist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
178015101
IDFPR LISENCE NUMBER
IL
Enumeration date
10/15/2019
Last updated
10/15/2019
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