MEDICARE: DR. SUE CHADWICK WALKER DMD

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	1223G0001X	General Practice Dentistry	D7111	OR

General Provider Information

NPI Number	:	1821099524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUE CHADWICK WALKER DMD

Provider Business Mailing Address
First Line	:	11147 SE 21ST AVE
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-7675
Country	:	US
Telephone Number	:	503-659-5222
Fax Number	:	503-659-6022

Provider Business Practice Location Address
First Line	:	11147 SE 21ST AVE
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-7675
Country	:	US
Telephone Number	:	503-659-2522
Fax Number	:	503-659-6022

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	05/21/2021

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