Provider Demographics
NPI:1881775039
Name:WALKER, ANDREA I (LICSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:I
Last Name:WALKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 10TH AVE S. SUITE 4
Mailing Address - Street 2:#101
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2680
Mailing Address - Country:US
Mailing Address - Phone:406-642-0506
Mailing Address - Fax:406-851-6284
Practice Address - Street 1:15 ALISSA LN
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-6154
Practice Address - Country:US
Practice Address - Phone:406-642-0506
Practice Address - Fax:406-851-6284
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MTBBH-LCSW-LIC-573441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor