Provider Demographics
NPI:1073893574
Name:WALKER, JEAN MARIE (MSSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN MARIE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:CENTER RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05736-9757
Mailing Address - Country:US
Mailing Address - Phone:802-353-9067
Mailing Address - Fax:
Practice Address - Street 1:71 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:CENTER RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05736-9757
Practice Address - Country:US
Practice Address - Phone:802-353-9067
Practice Address - Fax:802-774-5012
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00004881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical