Provider Demographics
NPI:1912444241
Name:WALTERS, MARIE (LSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 W SOUTH BOUNDARY ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5234
Mailing Address - Country:US
Mailing Address - Phone:419-873-8280
Mailing Address - Fax:
Practice Address - Street 1:1090 W SOUTH BOUNDARY ST
Practice Address - Street 2:SUITE 600
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5234
Practice Address - Country:US
Practice Address - Phone:419-873-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical