Provider Demographics
NPI:1215184015
Name:WALTON, JUDITH DIANE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:DIANE
Last Name:WALTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:DIANE
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1151 TAYLOR ST
Mailing Address - Street 2:BLDG 6,
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-970-3027
Mailing Address - Fax:
Practice Address - Street 1:1151 TAYLOR ST
Practice Address - Street 2:ROOM 332-C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802061047104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker