Provider Demographics
NPI:1700215118
Name:WALT, RYAN MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MARIE
Last Name:WALT
Suffix:
Gender:F
Credentials:MS 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:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:COLLYER
Mailing Address - State:KS
Mailing Address - Zip Code:67631-0054
Mailing Address - Country:US
Mailing Address - Phone:620-583-4772
Mailing Address - Fax:
Practice Address - Street 1:94 LEWIS DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4020
Practice Address - Country:US
Practice Address - Phone:785-625-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3530235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist