Provider Demographics
NPI:1952110421
Name:WALBURG, HEATHER DAWN (MAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:WALBURG
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9418 TOLEDO AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2051
Mailing Address - Country:US
Mailing Address - Phone:612-860-4194
Mailing Address - Fax:
Practice Address - Street 1:121 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-2514
Practice Address - Country:US
Practice Address - Phone:855-454-2463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor