MEDICARE: TRISH I WALTZ LCSW

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	104100000X	Social Worker	7474-C	AR

General Provider Information

NPI Number	:	1609973254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISH I WALTZ LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1060
Second Line	:
City	:	MARSHALL
State	:	AR
Zip	:	72650-1060
Country	:	US
Telephone Number	:	870-448-5733
Fax Number	:	870-448-3767

Provider Business Practice Location Address
First Line	:	2263 HWY 65 NORTH
Second Line	:
City	:	MARSHALL
State	:	AR
Zip	:	72650-1060
Country	:	US
Telephone Number	:	870-448-5733
Fax Number	:	870-448-3392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	02/02/2023

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Directions to “ TRISH I WALTZ LCSW” Practice Location

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