Provider Demographics
NPI:1730470444
Name:WALTER, JAMIE (PSYD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:DUSOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-9000
Mailing Address - Fax:
Practice Address - Street 1:10730 W 143RD ST
Practice Address - Street 2:STE 37
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1939
Practice Address - Country:US
Practice Address - Phone:800-564-0863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009229103G00000X
IL180007430174400000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No174400000XOther Service ProvidersSpecialist