Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | SW130016 | PA |
NPI | 1003152828 |
---|---|
Provider Name | Kelly Walker |
First Address | Philadelphia, PA 19148-2409 |
Second Address | Philadelphia, PA 19145-2328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2012 |
Last Update Date | 26/12/2012 |