Provider Demographics
NPI:1417131129
Name:CALLAGHAN, LAUREN KAY (LICSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KAY
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:KAY
Other - Last Name:WILKENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 OAKDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2926
Mailing Address - Country:US
Mailing Address - Phone:763-520-5470
Mailing Address - Fax:763-520-5470
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2926
Practice Address - Country:US
Practice Address - Phone:763-520-5470
Practice Address - Fax:763-520-5470
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN178581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical