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NPI Code Detail

MEDICARE: FRED WAYNE WALKER LCSW

MEDICARE: FRED WAYNE WALKER LCSW
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
11041C0700XClinical Social WorkerSW7321FL

General Provider Information

NPI Number : 1528042504
Entity Type Code : Individual
Provider Name (Legal Business Name) : FRED WAYNE WALKER LCSW
Provider Business Mailing Address
First Line : 1350 ALMOND ST
Second Line :
City : ORANGE CITY
State : FL
Zip : 32763-3802
Country : US
Telephone Number : 386-774-2807
Fax Number : 386-239-6675
Provider Business Practice Location Address
First Line : 1150 RED JOHN DR
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32124-1016
Country : US
Telephone Number : 386-236-1739
Fax Number : 386-239-6675
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2005
Last Update Date : 07/08/2007

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Directions to “ FRED WAYNE WALKER LCSW” Practice Location

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