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NPI Code Detail

MEDICARE: THADIOUS WALKER LADC

MEDICARE: THADIOUS WALKER LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor307575MN

General Provider Information

NPI Number : 1871441469
Entity Type Code : Individual
Provider Name (Legal Business Name) : THADIOUS WALKER LADC
Provider Business Mailing Address
First Line : 5750 SANDER DR APT 3
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55417-2841
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8550 HUDSON BLVD N
Second Line :
City : LAKE ELMO
State : MN
Zip : 55042-5500
Country : US
Telephone Number : 651-254-8580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2026
Last Update Date : 03/19/2026

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Directions to “ THADIOUS WALKER LADC” Practice Location

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