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General NPI Number Information
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NPI Number | 1497552293
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Entity Type | Individual
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Provider Name | KELLY JEAN WALK
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Gender | Female
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 33930 WEYERHAEUSER WAY S STE 220
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City | FEDERAL WAY
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State | WA
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Zip | 98001-9772
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Country | US
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Telephone | 253-550-0734
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Fax |
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Provider Business Mailing Address
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Address Line | 11107 LAKE STEILACOOM DR SW
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City | LAKEWOOD
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State | WA
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Zip | 98498-6729
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Country | US
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Telephone | 253-579-2937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC61411063
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License Number State | WA
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