Provider Demographics
NPI:1992490262
Name:WALKER, ANDREW DENNIS (SUDPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:DENNIS
Last Name:WALKER
Suffix:
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 DALE WAY
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5145
Mailing Address - Country:US
Mailing Address - Phone:425-772-6483
Mailing Address - Fax:
Practice Address - Street 1:2732 GRAND AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3416
Practice Address - Country:US
Practice Address - Phone:425-259-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61402258101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)