Provider Demographics
NPI:1174633929
Name:WALKER, JOHNNY CORRACE (MSSW)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:CORRACE
Last Name:WALKER
Suffix:
Gender:M
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:PO BOX 1612
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-1612
Mailing Address - Country:US
Mailing Address - Phone:503-762-1866
Mailing Address - Fax:
Practice Address - Street 1:10163 SE SUNNYSIDE RD STE 490
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5720
Practice Address - Country:US
Practice Address - Phone:503-653-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0015811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical