Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 304933 | MN |
NPI | 1003311655 |
---|---|
Provider Name | Ms. Cheryl Lee Walter |
First Address | Willmar, MN 56201-3475 |
Second Address | Willmar, MN 56201-3475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2018 |
Last Update Date | 27/03/2018 |