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General NPI Number Information
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NPI Number | 1184955627
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Entity Type | Individual
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Provider Name | KATHLEEN WALSH MT-BC, M.ED., BCBA
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Gender | Female
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 3341 E QUEEN CREEK RD STE 109
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City | GILBERT
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State | AZ
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Zip | 85297
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Country | US
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Telephone | 480-621-8361
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 E WILDHORSE DR
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City | GILBERT
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State | AZ
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Zip | 85297-7790
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 05280
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-101
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License Number State | AZ
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