Provider Demographics
NPI:1780206920
Name:WALWORTH, EMILY BROOKE (RBT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BROOKE
Last Name:WALWORTH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 S MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-4309
Mailing Address - Country:US
Mailing Address - Phone:517-312-1710
Mailing Address - Fax:
Practice Address - Street 1:1424 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4309
Practice Address - Country:US
Practice Address - Phone:517-312-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician