Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003203191 |
---|---|
Provider Name | Michael Walmer |
First Address | Madison, WI 53711-6275 |
Second Address | Madison, WI 53703-2637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 31/08/2016 |