Provider Demographics
NPI:1972925121
Name:WALSH, VICTORIA MARIE
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:MARIE
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:RANALLO-WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:1477 S KNOWLES AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2529
Mailing Address - Country:US
Mailing Address - Phone:715-246-4840
Mailing Address - Fax:715-246-4108
Practice Address - Street 1:1477 S KNOWLES AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-2529
Practice Address - Country:US
Practice Address - Phone:715-246-4840
Practice Address - Fax:715-246-4108
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5247-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional