Provider Demographics
NPI:1669059515
Name:WALKER, MICHAEL (MACF-SLP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:MACF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 WATERSIDE DR APT 208
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9741
Mailing Address - Country:US
Mailing Address - Phone:440-537-6269
Mailing Address - Fax:
Practice Address - Street 1:1341 PARADISE RD
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-8503
Practice Address - Country:US
Practice Address - Phone:252-482-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist