Provider Demographics
NPI:1558990143
Name:WALKER, WENDY SUE (LICSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:WALKER
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 1:1405 LILAC DR N STE 151
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4536
Mailing Address - Country:US
Mailing Address - Phone:763-525-9919
Mailing Address - Fax:763-486-4436
Practice Address - Street 1:1405 LILAC DR N STE 151
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4536
Practice Address - Country:US
Practice Address - Phone:763-525-9919
Practice Address - Fax:763-486-4436
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical