Healthcare Provider Details

I. General information

NPI: 1144075037
Provider Name (Legal Business Name): DANETTA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N MICHIGAN ST STE 910
TOLEDO OH
43604-5665
US

IV. Provider business mailing address

5111 AUTO CLUB DR STE 200
DEARBORN MI
48126-2749
US

V. Phone/Fax

Practice location:
  • Phone: 419-206-1044
  • Fax:
Mailing address:
  • Phone: 313-406-5056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: