Provider Demographics
NPI:1801494141
Name:WALKER, DEANDRA BOBBY (LCSW)
Entity type:Individual
Prefix:
First Name:DEANDRA
Middle Name:BOBBY
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:DEANDRA
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:16 N CARROLL ST STE 750
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2783
Mailing Address - Country:US
Mailing Address - Phone:608-571-7572
Mailing Address - Fax:
Practice Address - Street 1:16 N CARROLL ST STE 750
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2783
Practice Address - Country:US
Practice Address - Phone:608-571-7572
Practice Address - Fax:608-709-1744
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11262-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical