1215105077 NPI number — MRS. KATHERINE LYNN WALKER LMSW ACSW

Table of content: MRS. KATHERINE LYNN WALKER LMSW ACSW (NPI 1215105077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215105077 NPI number — MRS. KATHERINE LYNN WALKER LMSW ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
KATHERINE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215105077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
276 VESTER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERNDALE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-217-2242
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29895 GREENFIELD
Provider Second Line Business Practice Location Address:
SUITE 104B
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-905-5230
Provider Business Practice Location Address Fax Number:
248-905-5233
Provider Enumeration Date:
02/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801086861 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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