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NPI Code Detail

MEDICARE: CRYSTAL WALKER MSSA, LISW-S

MEDICARE: CRYSTAL WALKER MSSA, LISW-S
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 WorkerI-9676 (SUPV)OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000291469OTHEROHANTHEM PIN NUMBER
2579472000OTHEROHMAGELLAN MIS NUMBER

General Provider Information

NPI Number : 1558304964
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL WALKER MSSA, LISW-S
Provider Business Mailing Address
First Line : 3518 W 25TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1951
Country : US
Telephone Number : 216-741-2241
Fax Number : 216-741-2632
Provider Business Practice Location Address
First Line : 3518 W 25TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1951
Country : US
Telephone Number : 216-741-2241
Fax Number : 216-741-2632
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 02/04/2016

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Directions to “ CRYSTAL WALKER MSSA, LISW-S” Practice Location

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