Individual
ERICA L WALWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LMFT CEDS RDN LD
Contact information
Practice address
412 S SCOTT RD, FORT WAYNE, IN 46814
(260) 358-7180
Mailing address
11330 EAGLE CREST TRL, FORT WAYNE, IN 46845-1186
(260) 489-9009
(260) 489-5057
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35001890A
IN
133V00000X
Registered Dietitian
37001673A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0893263
AMERICAN DIETETIC ASSOCIA
—
01
—
893263
CDR
—
Enumeration date
08/21/2006
Last updated
08/15/2019
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