Provider Demographics
NPI:1821174566
Name:WALKER, ANGIE L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 W LINCOLN TRAIL BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2604
Mailing Address - Country:US
Mailing Address - Phone:270-351-8976
Mailing Address - Fax:270-351-8980
Practice Address - Street 1:750 W LINCOLN TRAIL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2604
Practice Address - Country:US
Practice Address - Phone:270-351-8976
Practice Address - Fax:270-351-8980
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY06591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82006594Medicaid
KY0359808Medicare PIN
KY82006594Medicaid