Provider Demographics
NPI:1386016459
Name:WALLS, MONICA (MS)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:WALLS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W HENDRICKSON RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3367
Mailing Address - Country:US
Mailing Address - Phone:360-582-3506
Mailing Address - Fax:
Practice Address - Street 1:301 W HENDRICKSON RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3367
Practice Address - Country:US
Practice Address - Phone:360-582-3506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA521684A103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool