Provider Demographics
NPI:1629128459
Name:WALKER, EDNA T (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:T
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:EDNA
Other - Middle Name:
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15754 ASHTON RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1304
Mailing Address - Country:US
Mailing Address - Phone:313-836-5930
Mailing Address - Fax:313-836-5930
Practice Address - Street 1:15754 ASHTON RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-1304
Practice Address - Country:US
Practice Address - Phone:313-836-5930
Practice Address - Fax:313-836-5930
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010075471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical