Provider Demographics
NPI:1952866543
Name:WALKER, TASHA) (PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:TASHA)
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5828 PAMPLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63147-1018
Mailing Address - Country:US
Mailing Address - Phone:314-265-2713
Mailing Address - Fax:
Practice Address - Street 1:5828 PAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63147-1018
Practice Address - Country:US
Practice Address - Phone:314-265-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOS20588707103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS20488707Medicaid