Healthcare Provider Details

I. General information

NPI: 1508590498
Provider Name (Legal Business Name): MELISSA ROSE WALTERS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9575 ETHAN WADE WAY SE
SNOQUALMIE WA
98065
US

IV. Provider business mailing address

PO BOX 969
SNOQUALMIE WA
98065-0969
US

V. Phone/Fax

Practice location:
  • Phone: 425-363-2069
  • Fax:
Mailing address:
  • Phone: 425-888-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: