Healthcare Provider Details

I. General information

NPI: 1659076628
Provider Name (Legal Business Name): JENNIFER LYNN WALKER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 14TH ST W
WILLISTON ND
58801-4063
US

IV. Provider business mailing address

2806 23RD ST W
WILLISTON ND
58801-2577
US

V. Phone/Fax

Practice location:
  • Phone: 701-651-6437
  • Fax: 701-516-8462
Mailing address:
  • Phone: 701-651-6437
  • Fax: 701-516-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1025
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61398071
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: