Provider Demographics
NPI:1184058539
Name:WALKER, JILL M (MAC, LAC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17700 WHITE GROUND RD
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-9427
Mailing Address - Country:US
Mailing Address - Phone:240-477-3435
Mailing Address - Fax:
Practice Address - Street 1:17700 WHITE GROUND RD
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-9427
Practice Address - Country:US
Practice Address - Phone:240-477-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02068171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist