Provider Demographics
NPI:1841795796
Name:WALKER, NICKEISHA J (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:NICKEISHA
Middle Name:J
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 STONE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3940
Mailing Address - Country:US
Mailing Address - Phone:860-549-4807
Mailing Address - Fax:
Practice Address - Street 1:27 STONE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3940
Practice Address - Country:US
Practice Address - Phone:860-549-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-17-29812103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst