Provider Demographics
NPI:1316765407
Name:WALTERS, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 ORCHARD DR APT 6
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-2970
Mailing Address - Country:US
Mailing Address - Phone:708-600-3717
Mailing Address - Fax:
Practice Address - Street 1:3635 ORCHARD DR APT 6
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-2970
Practice Address - Country:US
Practice Address - Phone:708-600-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician