Provider Demographics
NPI:1730238445
Name:WALKER, WALTER RAND (PHD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:RAND
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:RAND
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2301 WEST A STREET SUITE C
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843
Mailing Address - Country:US
Mailing Address - Phone:208-883-1144
Mailing Address - Fax:208-883-8062
Practice Address - Street 1:2301 W A ST STE C
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4042
Practice Address - Country:US
Practice Address - Phone:208-883-1144
Practice Address - Fax:208-883-8062
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY281103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical