Individual
DR. PHYLLIS ANNETTE WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9220 BONITA BEACH RD SE STE 222, BONITA SPRINGS, FL 34135-4235
(239) 404-9396
Mailing address
16128 PARQUE LN, NAPLES, FL 34110-2816
(239) 404-9396
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
SS756
FL
103TS0200X
School Psychologist
Primary
SS756
FL
Other
Enumeration date
11/19/2019
Last updated
11/19/2019
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