Healthcare Provider Details

I. General information

NPI: 1336601376
Provider Name (Legal Business Name): MANNING WALKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 1/2 1ST ST
MARYSVILLE CA
95901
US

IV. Provider business mailing address

1775 DAVIS RD S
SALEM OR
97306
US

V. Phone/Fax

Practice location:
  • Phone: 541-246-4201
  • Fax:
Mailing address:
  • Phone: 541-246-4201
  • Fax: 541-342-7987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number140910
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-AEOZIG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: