Provider Demographics
NPI:1770215303
Name:WALKER, BONNIE ARLENE (CSWA, MSW, CTP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ARLENE
Last Name:WALKER
Suffix:
Gender:F
Credentials:CSWA, MSW, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20712 NE KRISTEN CIR
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-8914
Mailing Address - Country:US
Mailing Address - Phone:772-643-1101
Mailing Address - Fax:
Practice Address - Street 1:1505 NE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1911
Practice Address - Country:US
Practice Address - Phone:503-688-5361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA133651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical