Provider Demographics
NPI:1003124504
Name:WALKER, MARCI JO (SLP)
Entity type:Individual
Prefix:MRS
First Name:MARCI
Middle Name:JO
Last Name:WALKER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 PEARCE WAY
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9180
Mailing Address - Country:US
Mailing Address - Phone:502-807-7995
Mailing Address - Fax:502-241-5922
Practice Address - Street 1:5413 PEARCE WAY
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-9180
Practice Address - Country:US
Practice Address - Phone:502-807-7995
Practice Address - Fax:502-241-5922
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-2537OtherKENTUCKY BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY LICENSE
12045415OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION