Provider Demographics
NPI:1447794946
Name:WALKER-SYPH, JAMIE (LISW-S)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WALKER-SYPH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 COMMANCHE CT
Mailing Address - Street 2:SUITE F
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-9055
Mailing Address - Country:US
Mailing Address - Phone:216-320-8384
Mailing Address - Fax:216-320-6488
Practice Address - Street 1:22001 FAIRMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4819
Practice Address - Country:US
Practice Address - Phone:216-320-8384
Practice Address - Fax:216-320-6488
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1502365-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0197475Medicaid