Provider Demographics
NPI:1497198469
Name:WALKER, GRETCHEN E (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:E
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12247 SE 35TH CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-8600
Mailing Address - Country:US
Mailing Address - Phone:503-730-7812
Mailing Address - Fax:
Practice Address - Street 1:12247 SE 35TH CT
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-8600
Practice Address - Country:US
Practice Address - Phone:503-730-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60122614235Z00000X
OR11051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist