MEDICARE: MS. VICTORIA MARIE WALSH

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	101YP2500X	Professional Counselor	5247-125	WI

General Provider Information

NPI Number	:	1972925121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICTORIA MARIE WALSH

Provider Business Mailing Address
First Line	:	1477 S KNOWLES AVE
Second Line	:	SUITE 130
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2529
Country	:	US
Telephone Number	:	715-246-4840
Fax Number	:	715-246-4108

Provider Business Practice Location Address
First Line	:	1477 S KNOWLES AVE
Second Line	:	SUITE 130
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2529
Country	:	US
Telephone Number	:	715-246-4840
Fax Number	:	715-246-4108

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

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	05/14/2014

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