Provider Demographics
NPI:1962157248
Name:WALKER-MATHEW, KEISHA JANAY (LCSW)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:JANAY
Last Name:WALKER-MATHEW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 S HARPER AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4119
Mailing Address - Country:US
Mailing Address - Phone:872-763-4405
Mailing Address - Fax:
Practice Address - Street 1:5113 S HARPER AVE STE 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4119
Practice Address - Country:US
Practice Address - Phone:872-763-4405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0236741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical