Provider Demographics
NPI:1043632193
Name:WALKER, LEANN
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-1645
Mailing Address - Country:US
Mailing Address - Phone:707-784-4900
Mailing Address - Fax:707-399-4957
Practice Address - Street 1:210 S 7TH ST
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571-1645
Practice Address - Country:US
Practice Address - Phone:707-784-4900
Practice Address - Fax:707-399-4957
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health