1487199188 NPI number — MRS. CHRISTINE YVONNE WALTERS SLPA

Table of content: MRS. CHRISTINE YVONNE WALTERS SLPA (NPI 1487199188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487199188 NPI number — MRS. CHRISTINE YVONNE WALTERS SLPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTERS
Provider First Name:
CHRISTINE
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOK
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
YVONNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487199188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 E BEACON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTESANO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98563-9755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-249-1860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 E BEACON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTESANO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98563-9755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-249-1860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  SP 60198275 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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