Healthcare Provider Details

I. General information

NPI: 1679593156
Provider Name (Legal Business Name): WALTER DANIEL MUNN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 BROADWAY
DENVER CO
80205-2534
US

IV. Provider business mailing address

2185 BROADWAY
DENVER CO
80205-2534
US

V. Phone/Fax

Practice location:
  • Phone: 303-296-2244
  • Fax: 303-296-1709
Mailing address:
  • Phone: 303-296-2244
  • Fax: 303-296-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number179
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: