Healthcare Provider Details

I. General information

NPI: 1174229140
Provider Name (Legal Business Name): COURTNEY WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 PINEGROVE DR
DAYTON OH
45449-3343
US

IV. Provider business mailing address

2412 PINEGROVE DR
DAYTON OH
45449-3343
US

V. Phone/Fax

Practice location:
  • Phone: 937-952-8922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: