Active NPI
Jenifer Lin Walkowiak, PH.D.
- Clinical Neuropsychologist
- Boston, MA
National Provider Identifier
1407161557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 9502
- Practice address
- 800 Washington St
CCSN Suite 334
Boston, MA 02111-1552 - Phone
- (617) 636-6464
- NPI assigned
- Aug 13, 2010
- Last updated
- Jul 3, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PS016874 | PA | |
| Clinical Neuropsychologist | 103G00000X | 9502 | MA | Primary |
Addresses
Primary practice location
800 Washington St
CCSN Suite 334
Boston, MA 02111-1552
Mailing address
800 Washington St
CCSN Suite 334
Boston, MA 02111-1552
Phone (617) 636-6464
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS016874 | PA | MD | Clinical Neuropsychologist |
| 9502 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341273600000",
"number": "1407161557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 WASHINGTON ST",
"address_2": "CCSN SUITE 334",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111552",
"telephone_number": "617-636-6464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 WASHINGTON ST",
"address_2": "CCSN SUITE 334",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111552",
"telephone_number": "617-636-6464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALKOWIAK",
"first_name": "JENIFER",
"middle_name": "LIN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-13",
"last_updated": "2012-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "PA",
"license": "PS016874",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MA",
"license": "9502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.