Provider Demographics
NPI:1336204122
Name:WALKER, ADRIENE KAY (LMP)
Entity type:Individual
Prefix:MS
First Name:ADRIENE
Middle Name:KAY
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16817 LARCH WAY
Mailing Address - Street 2:G-103
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3318
Mailing Address - Country:US
Mailing Address - Phone:425-273-5564
Mailing Address - Fax:
Practice Address - Street 1:19410 36TH AVE W
Practice Address - Street 2:SUITE 9
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5747
Practice Address - Country:US
Practice Address - Phone:425-670-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist