Provider Demographics
NPI:1255995627
Name:WALKER, SUZANNE RENEE (LCSW, LISW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:RENEE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:SUZIE
Other - Middle Name:
Other - Last Name:HUMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4365 E. PECOS RD STE 119, ROOM B
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2334
Mailing Address - Country:US
Mailing Address - Phone:480-702-1710
Mailing Address - Fax:
Practice Address - Street 1:4365 E. PECOS RD STE 119, ROOM B
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8529
Practice Address - Country:US
Practice Address - Phone:480-702-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-185591041C0700X
OHI.20020311041C0700X
AZLMSW-177091041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical