Provider Demographics
NPI:1528115060
Name:RANDY WALKER, M.S.
Entity type:Organization
Organization Name:RANDY WALKER, M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:847-209-0631
Mailing Address - Street 1:1601 SHERMAN AVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5038
Mailing Address - Country:US
Mailing Address - Phone:847-209-0631
Mailing Address - Fax:
Practice Address - Street 1:1601 SHERMAN AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5038
Practice Address - Country:US
Practice Address - Phone:847-209-0631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty