Healthcare Provider Details

I. General information

NPI: 1508440702
Provider Name (Legal Business Name): JANET KAY WALK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST STE 200
WASHINGTON MO
63090-3129
US

IV. Provider business mailing address

851 E 5TH ST STE 200
WASHINGTON MO
63090-3129
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-8585
  • Fax: 636-239-8553
Mailing address:
  • Phone: 636-239-8585
  • Fax: 636-239-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2018019791
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: