Healthcare Provider Details

I. General information

NPI: 1669115143
Provider Name (Legal Business Name): MAGGIE REED WALLEY MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 W SHAW AVE STE 101
FRESNO CA
93711-3063
US

IV. Provider business mailing address

315 E 5TH ST STE 202
WATERLOO IA
50703-4757
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-5683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number16903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: