Provider Demographics
NPI:1730837329
Name:WALTERS, GENEAL POYNTER (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GENEAL
Middle Name:POYNTER
Last Name:WALTERS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 N FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-1557
Mailing Address - Country:US
Mailing Address - Phone:985-892-0869
Mailing Address - Fax:
Practice Address - Street 1:1615 N FLORIDA ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1557
Practice Address - Country:US
Practice Address - Phone:985-892-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist