Provider Demographics
NPI:1063652600
Name:DRYMALSKI, WALTER MATTHEW (SAC-IT)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:MATTHEW
Last Name:DRYMALSKI
Suffix:
Gender:M
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 TIMMIE DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3237
Mailing Address - Country:US
Mailing Address - Phone:414-737-8708
Mailing Address - Fax:
Practice Address - Street 1:1331 TIMMIE DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-3237
Practice Address - Country:US
Practice Address - Phone:414-737-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14757-130101YA0400X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)