Provider Demographics
NPI:1982154217
Name:WALTER, ALEXIS N (MSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:N
Last Name:WALTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 HUNTINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5041
Mailing Address - Country:US
Mailing Address - Phone:307-315-3168
Mailing Address - Fax:
Practice Address - Street 1:909 LONG DR STE A
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3282
Practice Address - Country:US
Practice Address - Phone:307-675-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-15791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical