Provider Demographics
NPI:1598026122
Name:WALKER, KATHLEEN DIANE
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DIANE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2562
Mailing Address - Country:US
Mailing Address - Phone:360-299-4249
Mailing Address - Fax:360-299-1369
Practice Address - Street 1:1211 24TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2562
Practice Address - Country:US
Practice Address - Phone:360-299-4249
Practice Address - Fax:360-299-1369
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC601623661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical