Provider Demographics
NPI:1225219082
Name:WALTMAN, MICHELLE R (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:R
Last Name:WALTMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-3969
Mailing Address - Country:US
Mailing Address - Phone:620-343-6111
Mailing Address - Fax:913-287-5024
Practice Address - Street 1:618 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-3969
Practice Address - Country:US
Practice Address - Phone:620-343-6111
Practice Address - Fax:913-287-5024
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical