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NPI Code Detail

MEDICARE: MRS. SHEILA MARIA WALTY LCSW

MEDICARE: MRS. SHEILA MARIA WALTY LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0234OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407863947
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHEILA MARIA WALTY LCSW
Provider Business Mailing Address
First Line : 1455 NW IRVING ST
Second Line : STE 200
City : PORTLAND
State : OR
Zip : 97209-2275
Country : US
Telephone Number : 503-842-7855
Fax Number : 971-339-0401
Provider Business Practice Location Address
First Line : 1455 NW IRVING ST
Second Line : STE 200
City : PORTLAND
State : OR
Zip : 97209-2275
Country : US
Telephone Number : 503-842-7855
Fax Number : 971-339-0401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 10/27/2019

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