MEDICARE: MRS. JENNIFER GOSNELL WALKER MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C002813	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417991506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER GOSNELL WALKER MSW, LCSW

Provider Business Mailing Address
First Line	:	1501 DOCK ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-4936
Country	:	US
Telephone Number	:	910-254-9898
Fax Number	:	910-254-9818

Provider Business Practice Location Address
First Line	:	5000 LAMBS PATH WAY
Second Line	:	THE YAHWEH CENTER CHILDREN'S VILLAGE
City	:	CASTLE HAYNE
State	:	NC
Zip	:	28429-6311
Country	:	US
Telephone Number	:	910-675-3533
Fax Number	:	910-675-3405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	09/30/2009

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