Healthcare Provider Details

I. General information

NPI: 1316100324
Provider Name (Legal Business Name): JENNIFER WALKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 W LOMBARD ST
SPRINGFIELD MO
65806-2720
US

IV. Provider business mailing address

3459 S BRUNSWICK AVE
SPRINGFIELD MO
65809-4133
US

V. Phone/Fax

Practice location:
  • Phone: 417-865-1646
  • Fax: 417-866-1483
Mailing address:
  • Phone: 417-883-8891
  • Fax: 417-883-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2005013954
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: