MEDICARE: LETT, ROHDE, & WALLING, PC

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
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1598228777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LETT, ROHDE, & WALLING, PC

Provider Business Mailing Address
First Line	:	2530 S ALMA SCHOOL RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-4016
Country	:	US
Telephone Number	:	602-434-0249
Fax Number	:	480-704-5550

Provider Business Practice Location Address
First Line	:	8607 N 59TH AVE STE C6
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-5435
Country	:	US
Telephone Number	:	602-434-0249
Fax Number	:	480-704-5550

Authorized Official
Title or Position	:	PRESIDENT AND CLINICAL DIRECTOR
Name	:	DR. CURTIS CRAIG WALLING
Credential	:	PHD
Telephone Number	:	602-434-0249

Provider Enumeration Date	:	04/13/2019
Last Update Date	:	04/13/2019

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