Provider Demographics
NPI:1831257880
Name:WALKER, SAMANTHA (MCD)
Entity type:Individual
Prefix:MR
First Name:SAMANTHA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 CORDOVA LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7819
Mailing Address - Country:US
Mailing Address - Phone:870-219-0566
Mailing Address - Fax:
Practice Address - Street 1:2208 FOWLER AVE STE C
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6187
Practice Address - Country:US
Practice Address - Phone:870-931-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y357OtherBLUE CROSS & BLUE SHIELD