Provider Demographics
NPI:1073688917
Name:WALKER, WENDY ELIZABETH (MS)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ELIZABETH
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SOUTH NEWTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007
Mailing Address - Country:US
Mailing Address - Phone:507-377-1161
Mailing Address - Fax:507-377-2016
Practice Address - Street 1:117 SOUTH NEWTON AVENUE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007
Practice Address - Country:US
Practice Address - Phone:507-377-1161
Practice Address - Fax:507-377-2016
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0864103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN136382OtherUCARE
MN195G3WAOtherBCBS