Healthcare Provider Details

I. General information

NPI: 1780473363
Provider Name (Legal Business Name): JESSICA LYNN WALKNER M.A., P.P.S, L.E.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 M ST
ARCATA CA
95521-5741
US

IV. Provider business mailing address

1720 M ST
ARCATA CA
95521-5741
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-2406
  • Fax:
Mailing address:
  • Phone: 707-825-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number21048139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: