Provider Demographics
NPI:1417403296
Name:WALKER, LORI (LMFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:THIBODEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:5780 LINCOLN DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1640
Mailing Address - Country:US
Mailing Address - Phone:612-454-9291
Mailing Address - Fax:
Practice Address - Street 1:5780 LINCOLN DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436
Practice Address - Country:US
Practice Address - Phone:612-454-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2744106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist