Provider Demographics
NPI:1407408990
Name:WALKER, CHRISEAL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISEAL
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WOODCOTE DR
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-8448
Mailing Address - Country:US
Mailing Address - Phone:803-206-1186
Mailing Address - Fax:
Practice Address - Street 1:156 WOODCOTE DR
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-8448
Practice Address - Country:US
Practice Address - Phone:803-206-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist