Provider Demographics
NPI:1275026437
Name:WALKER, JENNIFER WINIFRED (SAC, LPC-IT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WINIFRED
Last Name:WALKER
Suffix:
Gender:F
Credentials:SAC, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 21ST PL S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6661
Mailing Address - Country:US
Mailing Address - Phone:608-498-0576
Mailing Address - Fax:
Practice Address - Street 1:2011 21ST PL S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6661
Practice Address - Country:US
Practice Address - Phone:608-498-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16031101YA0400X
WI3812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health