Provider Demographics
NPI:1629455415
Name:WALTERS, GINA MONICA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MONICA
Last Name:WALTERS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 AVALON PL
Mailing Address - Street 2:
Mailing Address - City:HAHNVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70057-2014
Mailing Address - Country:US
Mailing Address - Phone:504-442-0353
Mailing Address - Fax:
Practice Address - Street 1:108 AVALON PL
Practice Address - Street 2:
Practice Address - City:HAHNVILLE
Practice Address - State:LA
Practice Address - Zip Code:70057-2014
Practice Address - Country:US
Practice Address - Phone:504-442-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist