Provider Demographics
NPI:1174002372
Name:WALKER, GWENDOLYN DIANE (MSW)
Entity Type:Individual
Prefix:MISS
First Name:GWENDOLYN
Middle Name:DIANE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11973 E CANAL DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8211
Mailing Address - Country:US
Mailing Address - Phone:720-220-9385
Mailing Address - Fax:
Practice Address - Street 1:11973 E CANAL DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8211
Practice Address - Country:US
Practice Address - Phone:720-220-9385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8353104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker