Provider Demographics
NPI:1457123606
Name:BROWN WALKER, SHEVON
Entity Type:Individual
Prefix:
First Name:SHEVON
Middle Name:
Last Name:BROWN 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 1:2004 S ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-6224
Mailing Address - Country:US
Mailing Address - Phone:217-344-0674
Mailing Address - Fax:
Practice Address - Street 1:701 DEVONSHIRE DR STE C35
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7358
Practice Address - Country:US
Practice Address - Phone:217-552-4040
Practice Address - Fax:888-726-8634
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health