Provider Demographics
NPI:1023222957
Name:WALKER, KIERSTEN (EDS)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18380 W ESTES WAY
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9634
Mailing Address - Country:US
Mailing Address - Phone:623-536-8541
Mailing Address - Fax:
Practice Address - Street 1:18380 W ESTES WAY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9634
Practice Address - Country:US
Practice Address - Phone:623-536-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool