Provider Demographics
NPI:1063635951
Name:VANDEWALKER, DENISE JILL (LPC)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:JILL
Last Name:VANDEWALKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5861
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-0861
Mailing Address - Country:US
Mailing Address - Phone:503-979-4346
Mailing Address - Fax:503-980-7885
Practice Address - Street 1:401 RATCLIFF DR SE STE 10
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4980
Practice Address - Country:US
Practice Address - Phone:503-979-4346
Practice Address - Fax:503-980-7885
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2458101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional