MEDICARE: SUZANNE RENEE WALKER LCSW, LISW

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
1	1041C0700X	Clinical Social Worker	LCSW-18559	AZ
2	1041C0700X	Clinical Social Worker	I.2002031	OH
3	1041C0700X	Clinical Social Worker	LMSW-17709	AZ
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1255995627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE RENEE WALKER LCSW, LISW

Provider Business Mailing Address
First Line	:	4365 E. PECOS RD STE 119, ROOM B
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-2334
Country	:	US
Telephone Number	:	480-702-1710
Fax Number	:

Provider Business Practice Location Address
First Line	:	4365 E. PECOS RD STE 119, ROOM B
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-8529
Country	:	US
Telephone Number	:	480-702-1710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	08/03/2022

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