Provider Demographics
NPI:1841496171
Name:ABBOTT-WALK, CARRIE LYN (MED, DT)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYN
Last Name:ABBOTT-WALK
Suffix:
Gender:F
Credentials:MED, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3838
Mailing Address - Country:US
Mailing Address - Phone:815-758-3674
Mailing Address - Fax:815-756-1348
Practice Address - Street 1:529 S 7TH ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3838
Practice Address - Country:US
Practice Address - Phone:815-758-3674
Practice Address - Fax:815-756-1348
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCA1271102P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist