Provider Demographics
NPI:1356196794
Name:WALKER, DORLISA
Entity type:Individual
Prefix:
First Name:DORLISA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E HIGGINS RD STE 125X
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4788
Mailing Address - Country:US
Mailing Address - Phone:847-766-7604
Mailing Address - Fax:847-752-5162
Practice Address - Street 1:850 E HIGGINS RD STE 125X
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4788
Practice Address - Country:US
Practice Address - Phone:847-766-7604
Practice Address - Fax:847-752-5162
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL220.000269174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist