Individual
DIANA J WALZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
601 BUSINESS LOOP 70 W, COLUMBIA, MO 65203-2546
(573) 884-1400
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
(573) 884-8526
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW005946
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00130709
RR MEDICARE
MO
Enumeration date
05/02/2006
Last updated
07/08/2007
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