Provider Demographics
NPI:1932880986
Name:WALKER, SALLY (MA,BS)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA,BS
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:THOMASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,BS
Mailing Address - Street 1:1705 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-2258
Mailing Address - Country:US
Mailing Address - Phone:618-382-7311
Mailing Address - Fax:618-382-7552
Practice Address - Street 1:1705 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-2258
Practice Address - Country:US
Practice Address - Phone:618-382-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health