Provider Demographics
NPI:1215074034
Name:WALKER, ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:WALKER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SKYLINE CRST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4111
Mailing Address - Country:US
Mailing Address - Phone:360-738-4916
Mailing Address - Fax:360-312-3205
Practice Address - Street 1:270 WOLF CREEK RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862-9768
Practice Address - Country:US
Practice Address - Phone:360-738-4916
Practice Address - Fax:360-312-3205
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002522103T00000X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA524901001OtherGROUP HEALTH COOPERATIVE
WA14423OtherREGENCE
WA14423OtherREGENCE