Provider Demographics
NPI:1720384621
Name:WALKER, DENISE E (CADC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:E
Last Name:WALKER
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-5368
Mailing Address - Country:US
Mailing Address - Phone:208-934-8461
Mailing Address - Fax:208-934-5437
Practice Address - Street 1:5440 W FRANKLIN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1079
Practice Address - Country:US
Practice Address - Phone:208-336-9076
Practice Address - Fax:208-336-9079
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID10023101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)