Provider Demographics
NPI:1972262574
Name:VANDERWALKER, JOHN ANTHONY
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:VANDERWALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:HEPPNER
Mailing Address - State:OR
Mailing Address - Zip Code:97836-0898
Mailing Address - Country:US
Mailing Address - Phone:541-256-0664
Mailing Address - Fax:
Practice Address - Street 1:68982 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:HEPPNER
Practice Address - State:OR
Practice Address - Zip Code:97836-6258
Practice Address - Country:US
Practice Address - Phone:541-676-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty