Individual
MONICA WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
920 E MOUNTAIN SAGE DR, PHOENIX, AZ 85048-4430
(219) 313-8226
Mailing address
994 S HARRISON RD, TUCSON, AZ 85748-6608
(520) 721-1887
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
9957973
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9957973
THERAPEUTIC FOSTER CARE
AZ
Enumeration date
11/05/2019
Last updated
11/05/2019
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