Basic Information
| Provider Information | |||||||||
| NPI: | 1831457258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 517 W 100 N | ||||||||
| Address2: | STE 210 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843329826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357556061 | ||||||||
| FaxNumber: | 4359948362 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 COMMERCIAL WAY | ||||||||
| Address2: | |||||||||
| City: | ROCK SPRINGS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 829014671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357556061 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2012 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 8587228-3501 | UT | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LCSW-38968 | ID | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW-928 | WY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.