Provider Demographics
NPI:1023423878
Name:WALKER, MIRANDA STAR (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:STAR
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-2243
Mailing Address - Country:US
Mailing Address - Phone:614-582-9927
Mailing Address - Fax:
Practice Address - Street 1:500 MORSE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1833
Practice Address - Country:US
Practice Address - Phone:614-468-8718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist