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General NPI Number Information
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NPI Number | 1801331517
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Entity Type | Individual
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Provider Name | JEANNE LEE WALSH
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Gender | Female
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 300 COLORADO AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2006
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Country | US
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Telephone | 719-543-8711
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Fax | 719-543-0171
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Provider Business Mailing Address
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Address Line | 110 E ROUTT AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2117
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Country | US
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Telephone | 719-754-3187
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Fax | 719-543-1017
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0017884
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License Number State | CO
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