Provider Demographics
NPI:1316404197
Name:WALKER SPEECH THERAPY, INC.
Entity Type:Organization
Organization Name:WALKER SPEECH THERAPY, INC.
Other - Org Name:LORI WALKER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-763-6419
Mailing Address - Street 1:1301 REDWOOD WAY STE 165
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1136
Mailing Address - Country:US
Mailing Address - Phone:707-763-6419
Mailing Address - Fax:707-763-2537
Practice Address - Street 1:1301 REDWOOD WAY STE 165
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1136
Practice Address - Country:US
Practice Address - Phone:707-763-6419
Practice Address - Fax:707-763-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty