Provider Demographics
NPI:1609362151
Name:WALTER, BJORN VIKING (MA)
Entity Type:Individual
Prefix:MR
First Name:BJORN VIKING
Middle Name:
Last Name:WALTER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 WYCLIFF ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1257
Mailing Address - Country:US
Mailing Address - Phone:651-647-1083
Mailing Address - Fax:
Practice Address - Street 1:2380 WYCLIFF ST STE 102
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1257
Practice Address - Country:US
Practice Address - Phone:651-647-1083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health