Healthcare Provider Details

I. General information

NPI: 1881504439
Provider Name (Legal Business Name): MYRNA WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BOND AVE
HOLT MI
48842-1418
US

IV. Provider business mailing address

410 COTTONWOOD DR
LAPEER MI
48446-8648
US

V. Phone/Fax

Practice location:
  • Phone: 517-699-2106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14443405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: