Provider Demographics
NPI:1710013214
Name:WALKEN, JENNIFER WRIGHT (EDD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WRIGHT
Last Name:WALKEN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:W
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 WEST MILLBROOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4490
Mailing Address - Country:US
Mailing Address - Phone:919-782-4445
Mailing Address - Fax:919-782-4770
Practice Address - Street 1:207 WEST MILLBROOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4490
Practice Address - Country:US
Practice Address - Phone:919-782-4445
Practice Address - Fax:919-782-4770
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC76753OtherUBH
NC04874OtherBCBS
NC037021OtherVALUE OPTIONS