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NPI Code Detail

MEDICARE: CHYENNE MARIE WALTERS

MEDICARE: CHYENNE MARIE WALTERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2104100000XSocial Worker

General Provider Information

NPI Number : 1356747943
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHYENNE MARIE WALTERS
Provider Business Mailing Address
First Line : 40 W 300 S
Second Line :
City : SPRINGVILLE
State : UT
Zip : 84663-1329
Country : US
Telephone Number : 719-994-7645
Fax Number :
Provider Business Practice Location Address
First Line : 580 E 600 S
Second Line :
City : PROVO
State : UT
Zip : 84606-4806
Country : US
Telephone Number : 801-373-7443
Fax Number : 801-356-0322
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2014
Last Update Date : 04/27/2023

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Directions to “ CHYENNE MARIE WALTERS ” Practice Location

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