Provider Demographics
NPI:1609270123
Name:WALKER, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
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 1:4701 LAKELAND DR
Mailing Address - Street 2:#37B
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9506
Mailing Address - Country:US
Mailing Address - Phone:763-445-0921
Mailing Address - Fax:
Practice Address - Street 1:4701 LAKELAND DR
Practice Address - Street 2:#37B
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9506
Practice Address - Country:US
Practice Address - Phone:763-445-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC84951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical