MEDICARE: KATHRYN WALDEN

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1780345959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN WALDEN

Provider Business Mailing Address
First Line	:	1741 WINTER PARK RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-5816
Country	:	US
Telephone Number	:	407-463-7454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 TOWN PLAZA CT STE 2020
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6231
Country	:	US
Telephone Number	:	407-463-7454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/10/2022

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