Healthcare Provider Details

I. General information

NPI: 1184589566
Provider Name (Legal Business Name): J'LYNN WALTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 OHIO ST
TERRE HAUTE IN
47807-3940
US

IV. Provider business mailing address

908 W ELIZABETH ST
PARIS IL
61944-1608
US

V. Phone/Fax

Practice location:
  • Phone: 812-266-0974
  • Fax:
Mailing address:
  • Phone: 217-474-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: