Healthcare Provider Details

I. General information

NPI: 1790749521
Provider Name (Legal Business Name): LARAINE F WALKER PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 1ST ST W
HASTINGS MN
55033-1147
US

IV. Provider business mailing address

PO BOX 43 MR 10809
MINNEAPOLIS MN
55440-0043
US

V. Phone/Fax

Practice location:
  • Phone: 651-438-1800
  • Fax: 651-438-1894
Mailing address:
  • Phone: 612-262-4813
  • Fax: 612-262-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLP1306
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: