Provider Demographics
NPI:1104180405
Name:WALKER, SHIANNA RENAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIANNA
Middle Name:RENAE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1060 GAFFNEY RD
Mailing Address - Street 2:#7440
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-5001
Mailing Address - Country:US
Mailing Address - Phone:907-361-5418
Mailing Address - Fax:907-361-4847
Practice Address - Street 1:1060 GAFFNEY RD
Practice Address - Street 2:#7440
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-5001
Practice Address - Country:US
Practice Address - Phone:907-361-5418
Practice Address - Fax:907-361-4847
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY019763-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist