| Doctor Name: | NICOLE PRATTE WALTER |
| NPI Number: | 1225449895 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | OH1539092 |
| Business Practice Address: | 5490 Clyde Moore Dr. Suite C Groveport, OH - 43125 |
| Business Phone Number: | 6144922520 |
| Business Fax Number: | |
| Mailing Address: | 5490 Clyde Moore Dr., GROVEPORT |
| State: | OH |
| Postal Code: | 43125 |
| Phone Number: | 6144922520 |
| Fax Number: | |
| NPI Enumeration Date: | 05/16/2014 |
| NPI Last Update Date: | 05/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | OH1539092 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |