Provider Demographics
NPI:1629102553
Name:WALKER, KAREN LEONE (MCD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEONE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-2880
Mailing Address - Fax:801-387-2885
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:2645
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3271
Practice Address - Country:US
Practice Address - Phone:801-387-2880
Practice Address - Fax:801-387-2885
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110557-4101231H00000X
UT11057-4101237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000068181OtherMEDICARE PTAN
UTP00815626OtherMEDICARE RAILROAD