Healthcare Provider Details

I. General information

NPI: 1235975293
Provider Name (Legal Business Name): CRISTINA Y WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 14TH AVE
LONGVIEW WA
98632-2315
US

IV. Provider business mailing address

PO BOX 1847
LONGVIEW WA
98632-8140
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-0586
  • Fax: 360-577-0187
Mailing address:
  • Phone: 360-423-0203
  • Fax: 360-577-0187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61579123
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCG61579123
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: