Individual
MARIELLEN WALZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, MST
Contact information
Practice address
296 MOUACHE STREET, IGNACIO, CO 81137
(970) 563-4555
Mailing address
296 MOUACHE STREET, IGNACIO, CO 81137
(970) 563-4555
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1106-00
CO
Other
Enumeration date
05/05/2009
Last updated
05/05/2009
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