Provider Demographics
NPI:1437855285
Name:WALTERS, SHANTEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANTEL
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6196B MS HIGHWAY 567
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-5283
Mailing Address - Country:US
Mailing Address - Phone:601-597-4992
Mailing Address - Fax:
Practice Address - Street 1:6196B MS HIGHWAY 567
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645-5283
Practice Address - Country:US
Practice Address - Phone:601-597-4992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist