Provider Demographics
NPI:1649916800
Name:WALKER, SHAYLON
Entity type:Individual
Prefix:
First Name:SHAYLON
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SHAYLON
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR WALKER
Mailing Address - Street 1:38W601 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6178
Mailing Address - Country:US
Mailing Address - Phone:847-414-4090
Mailing Address - Fax:
Practice Address - Street 1:38W601 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6178
Practice Address - Country:US
Practice Address - Phone:847-414-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL739775103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL739775Medicaid
IL739775OtherEDUCATOR