Provider Demographics
NPI:1851052211
Name:WALKER, MAYSIE MALLOY (MA SLP)
Entity Type:Individual
Prefix:
First Name:MAYSIE
Middle Name:MALLOY
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38619 NINADELL AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7146
Mailing Address - Country:US
Mailing Address - Phone:440-622-1313
Mailing Address - Fax:
Practice Address - Street 1:7537 MENTOR AVE STE 303
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5463
Practice Address - Country:US
Practice Address - Phone:440-567-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20201426-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist