Provider Demographics
NPI:1356772180
Name:BLACK-WALKER, LIBBY
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:
Last Name:BLACK-WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:J
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9901 NE 7TH AVE
Mailing Address - Street 2:SUITE C116
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4523
Mailing Address - Country:US
Mailing Address - Phone:360-524-3440
Mailing Address - Fax:360-573-0404
Practice Address - Street 1:9901 NE 7TH AVE
Practice Address - Street 2:SUITE C116
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4523
Practice Address - Country:US
Practice Address - Phone:360-524-3440
Practice Address - Fax:360-573-0404
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst