Provider Demographics
NPI:1962679118
Name:WALTON, BETTY R (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:R
Last Name:WALTON
Suffix:
Gender:F
Credentials:MA 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 6204
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-0204
Mailing Address - Country:US
Mailing Address - Phone:757-871-5558
Mailing Address - Fax:844-336-3309
Practice Address - Street 1:4410 CLAIBORNE SQ E STE 334
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2074
Practice Address - Country:US
Practice Address - Phone:757-871-5558
Practice Address - Fax:844-336-3309
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001260235Z00000X
MD05244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1619312782Medicaid