Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor |
NPI | 1346400264 |
---|---|
Provider Name | Mr. Harold Wahlquist |
First Address | Bloomington, MN 55420-5614 |
Second Address | Bloomington, MN 55420-5614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2008 |
Last Update Date | 13/06/2008 |