Individual
DOROTHY MAE WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
RR 1 BOX 277, LAWRENCEVILLE, IL 62439
(618) 943-3754
Mailing address
P.O. BOX 516, LAWRENCEVILLE, IL 62439
(618) 943-3754
(618) 943-3657
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37600178008
—
IL
Enumeration date
06/22/2009
Last updated
06/22/2009
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