Provider Demographics
NPI:1407075054
Name:WALTERS, DONNA P (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:P
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 E SNOWCREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-3427
Mailing Address - Country:US
Mailing Address - Phone:801-809-7476
Mailing Address - Fax:
Practice Address - Street 1:1081 E SNOWCREEK DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-3427
Practice Address - Country:US
Practice Address - Phone:801-809-7476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5735208-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT260022408OtherRAILROAD MEDICARE
UT876000308007Medicaid
UT876000308007Medicaid