Provider Demographics
NPI:1306077896
Name:WALKER, JONATHAN REECE (MA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:REECE
Last Name:WALKER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10202 SE 32ND AVE
Mailing Address - Street 2:504
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-3610
Mailing Address - Country:US
Mailing Address - Phone:503-496-1190
Mailing Address - Fax:503-496-1195
Practice Address - Street 1:10202 SE 32ND AVE
Practice Address - Street 2:504
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-3610
Practice Address - Country:US
Practice Address - Phone:503-496-1190
Practice Address - Fax:503-496-1195
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR123190Medicaid