Provider Demographics
NPI:1528025814
Name:WALKER, KATHY J (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4455
Mailing Address - Country:US
Mailing Address - Phone:715-832-5454
Mailing Address - Fax:715-832-2991
Practice Address - Street 1:2005 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4455
Practice Address - Country:US
Practice Address - Phone:715-832-5454
Practice Address - Fax:715-832-2991
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3158123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN637871031035OtherPREFERRED ONE
MNHP39720OtherHEALTH PARTNERS
MN6258407OtherUHC
WI86702OtherSECURITY HEALTH PLAN
WI40926000Medicaid
MN6258407OtherMEDICA
MN6258407OtherUBH
MN648S3WAOtherBCBS MN