Healthcare Provider Details

I. General information

NPI: 1255923256
Provider Name (Legal Business Name): SUSAN WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HUMPHREY RD STE 4
GREENSBURG PA
15601-4571
US

IV. Provider business mailing address

225 HUMPHREY RD STE 4
GREENSBURG PA
15601-4571
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-9096
  • Fax: 724-832-2249
Mailing address:
  • Phone: 724-832-9096
  • Fax: 724-832-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS003508L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: