Provider Demographics
NPI:1154609022
Name:WALKER, KIMBERLY J (SACIT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:WALKER
Suffix:
Gender:F
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N OXFORD AVE
Mailing Address - Street 2:BOX 4
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5184
Mailing Address - Country:US
Mailing Address - Phone:171-583-4107
Mailing Address - Fax:715-834-1218
Practice Address - Street 1:2000 N OXFORD AVE
Practice Address - Street 2:BOX 4
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5184
Practice Address - Country:US
Practice Address - Phone:171-583-4107
Practice Address - Fax:715-834-1218
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16230-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)