Samantha Christine Walsh

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

420 Pennsylvania Ave Ste 101
Glen Ellyn, IL 60137-4427

Phone

(630) 474-4353

NPI assigned

Oct 15, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marvelous Minds, Inc

  • Mental Health Counselor
  • Glen Ellyn, IL
  • NPI 1902319916
  NPD
• Wheaton Wellness Center, Inc.

  • Counselor
  • Wheaton, IL
  • NPI 1255807244
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571097600000",
    "number": "1013559772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 PENNSYLVANIA AVE STE 101",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374427",
            "telephone_number": "630-474-4353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 PENNSYLVANIA AVE STE 101",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374427",
            "telephone_number": "630-474-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "SAMANTHA",
        "middle_name": "CHRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-15",
        "last_updated": "2019-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDFPR LISENCE NUMBER",
            "identifier": "178015101",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.marvelousminds.net/",
            "affiliation": "N",
            "address_1": "420 Pennsylvania Ave Ste 101",
            "city": "Glen Ellyn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601374427",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Walgreen Co
• Walgreen Co.
• Walgreen Co.
• Walmart Inc.
• Joy Walsh, LCSW
• Bruce Sonnenberg Wardell, DMD
• Leslie Briggs Wardell, DDS
• Karen Theresa Watkins, L.C.P.C.
• Michael Hunter Webb, MD
• Laura A Weese, AU.D.

• Counselor in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.