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General NPI Number Information
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NPI Number | 1922133180
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Entity Type | Individual
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Provider Name | KELLY WALKER LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 5455 WILSHIRE BLVD STE 2139
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City | LOS ANGELES
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State | CA
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Zip | 90036
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Country | US
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Telephone | 323-489-0205
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Fax |
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Provider Business Mailing Address
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Address Line | 8808 S 10TH AVE
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City | INGLEWOOD
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State | CA
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Zip | 90305-2327
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Country | US
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Telephone | 323-489-0205
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 23907
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7953C
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License Number State | NV
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