Provider Demographics
NPI:1457607186
Name:PIONTEK-WALSH, AUTUMN CHANDRA (MA)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:CHANDRA
Last Name:PIONTEK-WALSH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 S ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3417
Mailing Address - Country:US
Mailing Address - Phone:360-775-1071
Mailing Address - Fax:
Practice Address - Street 1:113 S EUNICE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3333
Practice Address - Country:US
Practice Address - Phone:360-775-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60293067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist