Provider Demographics
NPI:1982290102
Name:WALKER, MICHELLE R (BS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:WALKER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 OAK BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3620
Mailing Address - Country:US
Mailing Address - Phone:407-764-3328
Mailing Address - Fax:
Practice Address - Street 1:5449 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1722
Practice Address - Country:US
Practice Address - Phone:407-764-3328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health