Provider Demographics
NPI:1891934873
Name:WALKER, PAULETTE L (MSW, CAAC, LICSW)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSW, CAAC, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 15TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5231
Mailing Address - Country:US
Mailing Address - Phone:701-639-2421
Mailing Address - Fax:701-639-2421
Practice Address - Street 1:1121 WESTRAC DR S STE 202
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2385
Practice Address - Country:US
Practice Address - Phone:701-306-0542
Practice Address - Fax:701-306-0542
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI201903101YA0400X
ND46621041C0700X
MI68010897311041C0700X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant