Provider Demographics
NPI:1467146795
Name:WALTERS, ZACH (HIS)
Entity type:Individual
Prefix:
First Name:ZACH
Middle Name:
Last Name:WALTERS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8025
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5380
Practice Address - Street 1:6809 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-4202
Practice Address - Country:US
Practice Address - Phone:214-691-5466
Practice Address - Fax:214-691-7250
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3522237700000X
TX81196237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist