Provider Demographics
NPI:1750939757
Name:WALTERS, KRISTEN AMBER (SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:AMBER
Last Name:WALTERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:THAYNE
Mailing Address - State:WY
Mailing Address - Zip Code:83127-0860
Mailing Address - Country:US
Mailing Address - Phone:307-883-8877
Mailing Address - Fax:307-883-8876
Practice Address - Street 1:487A NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:THAYNE
Practice Address - State:WY
Practice Address - Zip Code:83127
Practice Address - Country:US
Practice Address - Phone:307-883-8877
Practice Address - Fax:307-883-8876
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist