Healthcare Provider Details

I. General information

NPI: 1215074034
Provider Name (Legal Business Name): ELLEN WALKER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 WOLF CREEK RD
WINTHROP WA
98862-9768
US

IV. Provider business mailing address

57 SKYLINE CRST
MONTEREY CA
93940-4111
US

V. Phone/Fax

Practice location:
  • Phone: 360-738-4916
  • Fax: 360-312-3205
Mailing address:
  • Phone: 360-738-4916
  • Fax: 360-312-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00002522
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY00002522
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002522
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: