Provider Demographics
NPI:1992887764
Name:WALKER, SANDRA CLEMENT (MD)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:CLEMENT
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1120 CHERRY STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2023
Mailing Address - Country:US
Mailing Address - Phone:206-624-0296
Mailing Address - Fax:206-624-1399
Practice Address - Street 1:1120 CHERRY STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2023
Practice Address - Country:US
Practice Address - Phone:206-624-0296
Practice Address - Fax:206-624-1399
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000328552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA114594OtherDOLI
WA1101526Medicaid
G43560Medicare UPIN