Provider Demographics
NPI:1487005922
Name:WALTER, MAILE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAILE
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WESLEY CROWELL RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-8198
Mailing Address - Country:US
Mailing Address - Phone:337-397-5510
Mailing Address - Fax:
Practice Address - Street 1:695 PETERSON ST
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-2647
Practice Address - Country:US
Practice Address - Phone:318-256-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist