Provider Demographics
NPI:1720394778
Name:WALKER, MARCIE K
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:K
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARCIE
Other - Middle Name:K
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6649 JACOBE ST NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-1188
Mailing Address - Country:US
Mailing Address - Phone:503-393-3872
Mailing Address - Fax:
Practice Address - Street 1:3180 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4532
Practice Address - Country:US
Practice Address - Phone:503-361-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health