Healthcare Provider Details

I. General information

NPI: 1679522452
Provider Name (Legal Business Name): CHERYL ANN WALTERS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: CHERYL ANN LORENTZEN

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY DR STE 200
DUBUQUE IA
52001
US

IV. Provider business mailing address

200 MERCY DR STE 200
DUBUQUE IA
52001
US

V. Phone/Fax

Practice location:
  • Phone: 563-582-0145
  • Fax: 563-582-0722
Mailing address:
  • Phone: 563-582-0145
  • Fax: 563-582-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00155
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: