Provider Demographics
NPI:1972089951
Name:WALTON, REBECCA LYN (EDS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYN
Last Name:WALTON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 W BOUNTIFUL WAY
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-4920
Mailing Address - Country:US
Mailing Address - Phone:801-694-1622
Mailing Address - Fax:
Practice Address - Street 1:442 W BOUNTIFUL WAY
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045
Practice Address - Country:US
Practice Address - Phone:801-694-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150152818103TS0200X
UT568658103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool