Provider Demographics
NPI:1881990919
Name:WALKER-SHEPHERD, HEATHER E (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:WALKER-SHEPHERD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 S OLIVER AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1459
Mailing Address - Country:US
Mailing Address - Phone:417-439-6612
Mailing Address - Fax:
Practice Address - Street 1:2910 S OLIVER AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1459
Practice Address - Country:US
Practice Address - Phone:417-439-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110403661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110-422-3940Medicaid
OK100746170GMedicaid
MOMA5353001Medicare UPIN