Provider Demographics
NPI:1164006623
Name:WALKER-FULLER, JAMIE LEE (MS, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEE
Last Name:WALKER-FULLER
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MCTAVISH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE EARTH
Mailing Address - State:ND
Mailing Address - Zip Code:58794-5003
Mailing Address - Country:US
Mailing Address - Phone:253-389-1874
Mailing Address - Fax:
Practice Address - Street 1:15 1ST ST SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-5878
Practice Address - Country:US
Practice Address - Phone:701-628-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL73103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst