Individual
RANDY WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED, ED.S.
Contact information
Practice address
701 N MARKET ST, TROY, OH 45373-1421
(937) 332-6730
Mailing address
701 N MARKET ST, TROY, OH 45373-1421
(937) 332-6730
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
20973784
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OH3053643
—
OH
Enumeration date
02/02/2015
Last updated
02/02/2015
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