Provider Demographics
NPI:1023011061
Name:LETIEN, WALTER CARY (AUD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:CARY
Last Name:LETIEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:266 CABOT ST
Mailing Address - Street 2:P.O. BOX 488
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3370
Mailing Address - Country:US
Mailing Address - Phone:978-922-1888
Mailing Address - Fax:978-927-4608
Practice Address - Street 1:266 CABOT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3370
Practice Address - Country:US
Practice Address - Phone:978-922-1888
Practice Address - Fax:978-927-4608
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9774726Medicaid
MA9774726Medicaid