Provider Demographics
NPI:1144690918
Name:WALTER, MOLLY ANNE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNE
Last Name:WALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2406
Mailing Address - Country:US
Mailing Address - Phone:720-419-2187
Mailing Address - Fax:720-491-1076
Practice Address - Street 1:3425 BLAKE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2406
Practice Address - Country:US
Practice Address - Phone:720-419-2187
Practice Address - Fax:720-491-1076
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-24670103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst