Healthcare Provider Details

I. General information

NPI: 1417131129
Provider Name (Legal Business Name): LAUREN KAY CALLAGHAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN KAY WILKENSON

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

IV. Provider business mailing address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-5470
  • Fax: 763-520-5470
Mailing address:
  • Phone: 763-520-5470
  • Fax: 763-520-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17858
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: