Provider Demographics
NPI:1194418020
Name:WALBRIDGE, MARI REID
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:REID
Last Name:WALBRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9015
Mailing Address - Country:US
Mailing Address - Phone:312-505-9775
Mailing Address - Fax:
Practice Address - Street 1:200 E 5TH AVE STE 109
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3173
Practice Address - Country:US
Practice Address - Phone:331-457-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490083881041C0700X
IL18189831041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical