Provider Demographics
NPI:1538637020
Name:WALKER, JESSE BASSETT (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:BASSETT
Last Name:WALKER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13637 60TH ST SW
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-4210
Mailing Address - Country:US
Mailing Address - Phone:320-286-2922
Mailing Address - Fax:320-286-2875
Practice Address - Street 1:13637 60TH ST SW
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-4210
Practice Address - Country:US
Practice Address - Phone:320-286-2922
Practice Address - Fax:320-286-2875
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist