Provider Demographics
NPI:1043458904
Name:WALKER, VALLA PENROSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VALLA
Middle Name:PENROSE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 HEWITT AVE STE 518
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3546
Mailing Address - Country:US
Mailing Address - Phone:425-595-3511
Mailing Address - Fax:626-628-3113
Practice Address - Street 1:1721 HEWITT AVE STE 518
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3546
Practice Address - Country:US
Practice Address - Phone:425-595-3511
Practice Address - Fax:626-628-3113
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22441103TC0700X
WAPY60759292103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical