Provider Demographics
NPI:1821199886
Name:ALLERY, WALTER A (MS/CCC-A)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:A
Last Name:ALLERY
Suffix:
Gender:M
Credentials:MS/CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 E ORCHARD LN TRLR 6
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-9695
Mailing Address - Country:US
Mailing Address - Phone:505-628-8680
Mailing Address - Fax:
Practice Address - Street 1:2402 W PIERCE ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3537
Practice Address - Country:US
Practice Address - Phone:505-234-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2073237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS0586Medicaid
NM8628OtherLOVRLACE HEALTCARE SYSTEM
NM37391OtherPRESBYTERIAN HEALTHCARE