Provider Demographics
NPI:1821175829
Name:WALKER, LEONIA MARIA (MS-CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LEONIA
Middle Name:MARIA
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS-CCC/SLP
Mailing Address - Street 1:6782 VLOSI DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4029
Mailing Address - Country:US
Mailing Address - Phone:704-817-7754
Mailing Address - Fax:
Practice Address - Street 1:6782 VLOSI DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4029
Practice Address - Country:US
Practice Address - Phone:704-817-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211844Medicaid