Provider Demographics
NPI:1548633209
Name:WALSH, CASEY (ND, PHD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:ND, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19817 26TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19817 26TH DR SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7253
Practice Address - Country:US
Practice Address - Phone:206-312-1985
Practice Address - Fax:206-339-1601
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60606635175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath