Provider Demographics
NPI:1922128164
Name:WALKER-GRANGER, JUDY (MS,CAP,ICADC,CMHP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:WALKER-GRANGER
Suffix:
Gender:F
Credentials:MS,CAP,ICADC,CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W ADAMS ST STE 401
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-1645
Mailing Address - Country:US
Mailing Address - Phone:904-742-5835
Mailing Address - Fax:904-212-0056
Practice Address - Street 1:630 W ADAMS ST
Practice Address - Street 2:STE 303
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1645
Practice Address - Country:US
Practice Address - Phone:904-742-5835
Practice Address - Fax:904-212-0056
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766528800Medicaid