MEDICARE: MS. LEE ELLEN WALKER MA

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	235Z00000X	Speech-Language Pathologist	4054	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548455439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEE ELLEN WALKER MA

Provider Business Mailing Address
First Line	:	800 FRUITA RD NE
Second Line	:	EAGLE RIDGE MIDDLE SCHOOL
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-6557
Country	:	US
Telephone Number	:	505-892-6630
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 FRUITA RD NE
Second Line	:	EAGLE RIDGE MIDDLE SCHOOL
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-6557
Country	:	US
Telephone Number	:	505-892-6630
Fax Number	:

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

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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Directions to “ MS. LEE ELLEN WALKER MA” Practice Location

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