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NPI Code Detail

MEDICARE: KIP WALKER LADC

MEDICARE: KIP WALKER LADC
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
1101Y00000XCounselor000375VT
2101YA0400XAddiction (Substance Use Disorder) Counselor000375VT
3101YM0800XMental Health Counselor000375VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100069095OTHERVTBLUE CROSS
22196448OTHERVTCIGNA

General Provider Information

NPI Number : 1467473983
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIP WALKER LADC
Provider Business Mailing Address
First Line : PO BOX 588
Second Line :
City : BENNINGTON
State : VT
Zip : 05201-0588
Country : US
Telephone Number : 802-442-5491
Fax Number : 802-442-4910
Provider Business Practice Location Address
First Line : 100 LEDGEHILL RD
Second Line :
City : BENNINGTON
State : VT
Zip : 05201-2273
Country : US
Telephone Number : 802-442-5491
Fax Number : 802-442-4910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 03/21/2008

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1114946035 — KARIN F MACK M.D.
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1740200609 — CATHERINE M HICKEY M.D.
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Directions to “ KIP WALKER LADC” Practice Location

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