Provider Demographics
NPI:1639302284
Name:WALTERS, LAURIE (MSW, LISW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4609
Mailing Address - Country:US
Mailing Address - Phone:563-322-7419
Mailing Address - Fax:563-322-5339
Practice Address - Street 1:111 W 15TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4609
Practice Address - Country:US
Practice Address - Phone:563-322-7419
Practice Address - Fax:563-322-5339
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health