Individual provider Active NPI

Jeff Walker, CDCA

  • Addiction (Substance Use Disorder) Counselor
  • Massillon, OH
National Provider Identifier
1104249523
Registry record updated Jan 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Practice address
1660 Nave Rd SE
Massillon, OH 44646-9604
Phone
(330) 837-1883
Fax
(330) 837-4603
NPI assigned
Jan 22, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X OH Primary

Addresses

Primary practice location

1660 Nave Rd SE
Massillon, OH 44646-9604

Mailing address

1341 Market Ave N
Canton, OH 44714-2605
Phone (330) 452-8252

Other identifiers 1

IdentifierTypeStateIssuer
2901131MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390348800000",
    "number": "1104249523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1341 MARKET AVE N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447142605",
            "telephone_number": "330-452-8252",
            "fax_number": "330-453-6716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 NAVE RD SE",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446469604",
            "telephone_number": "330-837-1883",
            "fax_number": "330-837-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "JEFF",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-22",
        "last_updated": "2014-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2901131",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Massillon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.