Provider Demographics
NPI:1528367448
Name:WALKER, LATRAY (MED/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LATRAY
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:MED/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 ADCOCK CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5104
Mailing Address - Country:US
Mailing Address - Phone:706-834-2794
Mailing Address - Fax:
Practice Address - Street 1:715 ADCOCK CT
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5104
Practice Address - Country:US
Practice Address - Phone:229-444-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist