Provider Demographics
NPI:1346568433
Name:WALDEN, KRISTY LEE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LEE
Last Name:WALDEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S 20TH AVE W STE A
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-3526
Mailing Address - Country:US
Mailing Address - Phone:218-733-1331
Mailing Address - Fax:218-733-0499
Practice Address - Street 1:5095 FISH LAKE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-8433
Practice Address - Country:US
Practice Address - Phone:218-733-1331
Practice Address - Fax:218-733-0499
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN135281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical