Provider Demographics
NPI:1538387121
Name:WALKER, DEAN ALAN (PHD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:ALAN
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 E 13TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4268
Mailing Address - Country:US
Mailing Address - Phone:541-683-5336
Mailing Address - Fax:542-683-5336
Practice Address - Street 1:492 E 13TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4268
Practice Address - Country:US
Practice Address - Phone:541-683-5336
Practice Address - Fax:542-683-5336
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1356103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR109923Medicare ID - Type UnspecifiedMEDICARE ID