Provider Demographics
NPI:1275805657
Name:WALRATH, WHITNEY RAE (LSW)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:RAE
Last Name:WALRATH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 25TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-6024
Mailing Address - Country:US
Mailing Address - Phone:330-936-7112
Mailing Address - Fax:
Practice Address - Street 1:1660 NAVE RD SE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9604
Practice Address - Country:US
Practice Address - Phone:330-837-1883
Practice Address - Fax:330-837-4603
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1100376104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker