Provider Demographics
NPI:1609388354
Name:WALTER, HEIDI ROSE (MSW,LISW,LIDCD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ROSE
Last Name:WALTER
Suffix:
Gender:F
Credentials:MSW,LISW,LIDCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6310
Mailing Address - Country:US
Mailing Address - Phone:740-387-5210
Mailing Address - Fax:
Practice Address - Street 1:320 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6310
Practice Address - Country:US
Practice Address - Phone:740-387-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1600307101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)