Provider Demographics
NPI:1124304514
Name:WALKER, JENNIE (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-2013
Mailing Address - Country:US
Mailing Address - Phone:989-348-8522
Mailing Address - Fax:989-348-6434
Practice Address - Street 1:204 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-2013
Practice Address - Country:US
Practice Address - Phone:989-348-8522
Practice Address - Fax:989-348-6434
Is Sole Proprietor?:No
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1570122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health