Healthcare Provider Details

I. General information

NPI: 1386016459
Provider Name (Legal Business Name): MONICA WALLS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HENDRICKSON RD
SEQUIM WA
98382-3367
US

IV. Provider business mailing address

301 W HENDRICKSON RD
SEQUIM WA
98382-3367
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-3506
  • Fax:
Mailing address:
  • Phone: 360-582-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number521684A
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: