Provider Demographics
NPI:1871630533
Name:WALGREN, MISCHEL B (PHD)
Entity Type:Individual
Prefix:DR
First Name:MISCHEL
Middle Name:B
Last Name:WALGREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 OAK GROVE STREET, LORING PARK OFFICE BUILDING
Mailing Address - Street 2:#407
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3234
Mailing Address - Country:US
Mailing Address - Phone:612-874-8937
Mailing Address - Fax:
Practice Address - Street 1:3805 KIPLING AVE
Practice Address - Street 2:MINNEAPOLIS, MN
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4945
Practice Address - Country:US
Practice Address - Phone:612-267-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30814WAOtherBLUE CROSS BLUE SHIELD