Provider Demographics
NPI:1487199188
Name:WALTERS, CHRISTINE YVONNE (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:YVONNE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:YVONNE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 E BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-9755
Mailing Address - Country:US
Mailing Address - Phone:360-249-1860
Mailing Address - Fax:
Practice Address - Street 1:1717 E BEACON AVE
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-9755
Practice Address - Country:US
Practice Address - Phone:360-249-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP 601982752355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant