Provider Demographics
NPI:1043382823
Name:WALKER-MEHLERT, BRENDA ANNE (CERTIFIED THERAPEUTI)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANNE
Last Name:WALKER-MEHLERT
Suffix:
Gender:F
Credentials:CERTIFIED THERAPEUTI
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:ANNE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3013 W GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053
Mailing Address - Country:US
Mailing Address - Phone:602-277-5551
Mailing Address - Fax:602-200-6039
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:CARL T HAYDEN VAMC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:602-200-6039
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
28847225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist