Provider Demographics
NPI:1689388597
Name:WALDEN, SKYE LORRINE (BA, AAC)
Entity Type:Individual
Prefix:
First Name:SKYE
Middle Name:LORRINE
Last Name:WALDEN
Suffix:
Gender:F
Credentials:BA, AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:WELLPINIT
Mailing Address - State:WA
Mailing Address - Zip Code:99040-0450
Mailing Address - Country:US
Mailing Address - Phone:509-606-2018
Mailing Address - Fax:509-258-4480
Practice Address - Street 1:6228 OLD SCHOOL RD.
Practice Address - Street 2:
Practice Address - City:WELLPINIT
Practice Address - State:WA
Practice Address - Zip Code:99040
Practice Address - Country:US
Practice Address - Phone:150-960-6201
Practice Address - Fax:509-258-4480
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61387175101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor