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NPI Code Detail

MEDICARE: MISS GWENDOLYN KAYE WALKER

MEDICARE:  MISS GWENDOLYN KAYE WALKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1053695981
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS GWENDOLYN KAYE WALKER
Provider Business Mailing Address
First Line : 2105 TRAVIS ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-4051
Country : US
Telephone Number : 702-752-6043
Fax Number :
Provider Business Practice Location Address
First Line : 2105 TRAVIS ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-4051
Country : US
Telephone Number : 702-752-6043
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2011
Last Update Date : 10/11/2011

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Directions to “ MISS GWENDOLYN KAYE WALKER ” Practice Location

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