Provider Demographics
NPI:1609142777
Name:WALKER, BENGT (LCO)
Entity Type:Individual
Prefix:
First Name:BENGT
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:LCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 LILLY RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6100
Mailing Address - Country:US
Mailing Address - Phone:360-459-1099
Mailing Address - Fax:360-459-1794
Practice Address - Street 1:208 LILLY RD NE STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6100
Practice Address - Country:US
Practice Address - Phone:360-459-1099
Practice Address - Fax:360-459-1794
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI 60252420222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist