Provider Demographics
NPI:1922555325
Name:JERRY WALKER THERAPY SERVICES
Entity Type:Organization
Organization Name:JERRY WALKER THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:217-228-6194
Mailing Address - Street 1:195 S 36TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5801
Mailing Address - Country:US
Mailing Address - Phone:217-228-6194
Mailing Address - Fax:217-209-0201
Practice Address - Street 1:195 S 36TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-5801
Practice Address - Country:US
Practice Address - Phone:217-228-6194
Practice Address - Fax:217-209-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty