Provider Demographics
NPI:1366723389
Name:WALKER, GEORGETTE M (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:GEORGETTE
Other - Middle Name:M
Other - Last Name:CARSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:309 WASHINGTON ST APT 4310
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4900
Mailing Address - Country:US
Mailing Address - Phone:631-793-9546
Mailing Address - Fax:
Practice Address - Street 1:1019 W 9TH AVE STE D
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1220
Practice Address - Country:US
Practice Address - Phone:610-992-9900
Practice Address - Fax:610-992-9999
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-03
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
PASL014393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist