Provider Demographics
NPI:1588842769
Name:WALD, LISA LOREEN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LOREEN
Last Name:WALD
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 WILLSON RD STE 480
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1342
Mailing Address - Country:US
Mailing Address - Phone:612-401-7340
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLSON RD STE 480
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1342
Practice Address - Country:US
Practice Address - Phone:612-401-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN145901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical