Provider Demographics
NPI:1710187315
Name:WALSH, MARGARET C (PHD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:C
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E WILLIAM ST APT 16H
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2427
Mailing Address - Country:US
Mailing Address - Phone:734-761-6221
Mailing Address - Fax:
Practice Address - Street 1:555 E WILLIAM ST APT 16H
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2427
Practice Address - Country:US
Practice Address - Phone:734-761-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005814103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION42960Medicare PIN