Provider Demographics
NPI:1891993986
Name:WALKER, SUSAN NELLIST (MA CCC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:NELLIST
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 ROY RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-9558
Mailing Address - Country:US
Mailing Address - Phone:360-331-3354
Mailing Address - Fax:360-678-0326
Practice Address - Street 1:1573 E. ROY RD.
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249
Practice Address - Country:US
Practice Address - Phone:360-678-7619
Practice Address - Fax:360-678-0326
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist