Provider Demographics
NPI:1467146795
Name:WALTERS, ZACH (HIS)
Entity Type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:WALTERS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7210
Mailing Address - Country:US
Mailing Address - Phone:309-736-2616
Mailing Address - Fax:815-397-4341
Practice Address - Street 1:3819 16TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7210
Practice Address - Country:US
Practice Address - Phone:309-736-2616
Practice Address - Fax:815-397-4341
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3522237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist