Provider Demographics
NPI:1699208744
Name:WALKER, AJA N (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AJA
Middle Name:N
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8649 A C SKINNER PKWY
Mailing Address - Street 2:APT. 611
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7473
Mailing Address - Country:US
Mailing Address - Phone:757-593-9434
Mailing Address - Fax:
Practice Address - Street 1:1000 W BROADWAY ST STE 214
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:407-359-5693
Practice Address - Fax:407-792-5693
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025046900Medicaid