Provider Demographics
NPI:1568471415
Name:WALRAD, JOSEPH HENRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HENRY
Last Name:WALRAD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9845 REECK RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1122
Mailing Address - Country:US
Mailing Address - Phone:313-382-3080
Mailing Address - Fax:313-382-9152
Practice Address - Street 1:9845 REECK RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1122
Practice Address - Country:US
Practice Address - Phone:313-382-3080
Practice Address - Fax:313-382-9152
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005772103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H24652Medicare PIN