Provider Demographics
NPI:1790445807
Name:WALKER, ANDREA LEIGH
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 WHITE BEAR PKWY STE 1500
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3697
Mailing Address - Country:US
Mailing Address - Phone:651-493-8150
Mailing Address - Fax:
Practice Address - Street 1:4505 WHITE BEAR PKWY STE 1500
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3697
Practice Address - Country:US
Practice Address - Phone:514-938-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health