Healthcare Provider Details

I. General information

NPI: 1770839185
Provider Name (Legal Business Name): WENDY COLLIER WALKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 I 55 N SUITE 450
JACKSON MS
39211-2651
US

IV. Provider business mailing address

5760 I 55 N SUITE 450
JACKSON MS
39211-2651
US

V. Phone/Fax

Practice location:
  • Phone: 601-956-4816
  • Fax: 601-956-4817
Mailing address:
  • Phone: 601-956-4816
  • Fax: 601-956-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC5384
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: