Provider Demographics
NPI:1790924959
Name:MASON, WALTER CHESTER (MSW)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:CHESTER
Last Name:MASON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 W MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3512
Mailing Address - Country:US
Mailing Address - Phone:414-383-4486
Mailing Address - Fax:414-383-4522
Practice Address - Street 1:634 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3512
Practice Address - Country:US
Practice Address - Phone:414-383-4486
Practice Address - Fax:414-383-4522
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator