Provider Demographics
NPI:1730396474
Name:WALTERS, MANDY MICHELE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:MICHELE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:600 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3180
Mailing Address - Country:US
Mailing Address - Phone:479-986-6081
Mailing Address - Fax:479-986-6107
Practice Address - Street 1:3101 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4900
Practice Address - Country:US
Practice Address - Phone:479-986-6081
Practice Address - Fax:479-986-6107
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARSP#1791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist