Provider Demographics
NPI:1821099524
Name:WALKER, SUE CHADWICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:CHADWICK
Last Name:WALKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11147 SE 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7675
Mailing Address - Country:US
Mailing Address - Phone:503-659-5222
Mailing Address - Fax:503-659-6022
Practice Address - Street 1:11147 SE 21ST AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7675
Practice Address - Country:US
Practice Address - Phone:503-659-2522
Practice Address - Fax:503-659-6022
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD71111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice