Basic Information
| Provider Information | |||||||||
| NPI: | 1346651775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RASAC 1 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 441 | ||||||||
| Address2: | |||||||||
| City: | HAYTI | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733592600 | ||||||||
| FaxNumber: | 5733591103 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 HWY J | ||||||||
| Address2: | |||||||||
| City: | HAYTI | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733592600 | ||||||||
| FaxNumber: | 5733591103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2014 | ||||||||
| LastUpdateDate: | 05/20/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 7786 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.