Healthcare Provider Details

I. General information

NPI: 1922069566
Provider Name (Legal Business Name): WALANDA WALKER SMITH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WALANDA VIOLET WALKER

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18789 N REEMS RD STE. 260
SURPRISE AZ
85374-8648
US

IV. Provider business mailing address

18789 N REEMS RD STE. 260
SURPRISE AZ
85374-8648
US

V. Phone/Fax

Practice location:
  • Phone: 623-544-3223
  • Fax: 623-544-3694
Mailing address:
  • Phone: 623-544-3223
  • Fax: 623-544-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3289
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3289
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: