Provider Demographics
NPI:1598096547
Name:WALKER-DOUGLAS, VERONICA D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:D
Last Name:WALKER-DOUGLAS
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 1:3938 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2262
Mailing Address - Country:US
Mailing Address - Phone:708-218-2271
Mailing Address - Fax:
Practice Address - Street 1:4749 LINCOLN MALL DR STE 202
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3807
Practice Address - Country:US
Practice Address - Phone:708-218-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0078091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical