=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952070534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA ANN WALKER LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2021
-----------------------------------------------------
Last Update Date | 09/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 W STATE ST
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83702-3958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-813-6246
-----------------------------------------------------
Fax | 208-813-6248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4419 NEWBRIDGE ST
-----------------------------------------------------
City | CALDWELL
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83607-4507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-340-2600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LMSW-37371
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------