Healthcare Provider Details

I. General information

NPI: 1235830514
Provider Name (Legal Business Name): MONET WALTERS MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 S I 10 SERVICE RD W
METAIRIE LA
70001-7405
US

IV. Provider business mailing address

4300 S I 10 SERVICE RD W
METAIRIE LA
70001-7405
US

V. Phone/Fax

Practice location:
  • Phone: 504-510-1743
  • Fax:
Mailing address:
  • Phone: 201-220-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1397710
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: