Provider Demographics
NPI:1639586837
Name:WALKER, JAMIE THERESE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:THERESE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:THERESE
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:361 COBALT BAY LOOP APT 104
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-1631
Mailing Address - Country:US
Mailing Address - Phone:425-283-2674
Mailing Address - Fax:
Practice Address - Street 1:607 MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5404
Practice Address - Country:US
Practice Address - Phone:425-403-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-20
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60414222103TC0700X
WARYT 117032174400000X
WAPY6041422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1144688565Medicaid
WAG8950489OtherMEDICARE