MEDICARE: MS. WANTING WALKER LPC

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	101YP2500X	Professional Counselor	1892	KS
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	A0100482	KS

General Provider Information

NPI Number	:	1477748374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WANTING WALKER LPC

Provider Business Mailing Address
First Line	:	2963 N LAWNDALE AVE STE 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7320
Country	:	US
Telephone Number	:	312-285-0534
Fax Number	:	316-267-3843

Provider Business Practice Location Address
First Line	:	2963 N LAWNDALE AVE STE 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7320
Country	:	US
Telephone Number	:	312-285-0534
Fax Number	:

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

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	04/16/2025

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