Provider Demographics
NPI:1245884709
Name:WALASINSKI, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WALASINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MONROE ST STE 232
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3462
Mailing Address - Country:US
Mailing Address - Phone:419-574-9290
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:5151 MONROE ST STE 232
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3462
Practice Address - Country:US
Practice Address - Phone:419-574-9290
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
RBT-19-81554106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist