Provider Demographics
NPI:1104212893
Name:WALKER, JENNIFER HANCOCK (LSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:HANCOCK
Last Name:WALKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 WHITTINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-8102
Mailing Address - Country:US
Mailing Address - Phone:267-325-5300
Mailing Address - Fax:423-822-5729
Practice Address - Street 1:4595 TOWNE LAKE PKWY
Practice Address - Street 2:BUILDING 300 SUITE 250
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5514
Practice Address - Country:US
Practice Address - Phone:267-325-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127399104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker