Provider Demographics
NPI:1639540388
Name:WALKER, REVA C
Entity type:Individual
Prefix:
First Name:REVA
Middle Name:C
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:REVA
Other - Middle Name:C
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA PSYCHOLOGY
Mailing Address - Street 1:856 E PERSHING RD
Mailing Address - Street 2:APT 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-2072
Mailing Address - Country:US
Mailing Address - Phone:773-425-5826
Mailing Address - Fax:
Practice Address - Street 1:6049 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2619
Practice Address - Country:US
Practice Address - Phone:219-756-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor