MEDICARE: MS. CAROLYN WALKER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	14163132	WI

General Provider Information

NPI Number	:	1790905586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN WALKER

Provider Business Mailing Address
First Line	:	4744 N 21ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-6333
Country	:	US
Telephone Number	:	414-263-6000
Fax Number	:	414-263-2270

Provider Business Practice Location Address
First Line	:	2821 N 4TH ST
Second Line	:	SUITE 516
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2362
Country	:	US
Telephone Number	:	414-263-6000
Fax Number	:	414-263-2270

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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