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General NPI Number Information
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NPI Number | 1972029262
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Entity Type | Individual
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Provider Name | SHANE WILLIAM WALKER LLCMSW
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Gender | Male
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 789 N CLARE AVE
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City | HARRISON
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State | MI
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Zip | 48625-8250
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Country | US
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Telephone | 989-539-2141
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 CUMMER ST
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City | CADILLAC
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State | MI
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Zip | 49601-1769
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Country | US
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Telephone | 231-429-3870
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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 | 6801101639
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License Number State | MI
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