Provider Demographics
NPI:1104594647
Name:WALDEN, EMILY LINNEA (CAPSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LINNEA
Last Name:WALDEN
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SUNDSTROM ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2003
Mailing Address - Country:US
Mailing Address - Phone:815-979-3797
Mailing Address - Fax:
Practice Address - Street 1:629 RIVER ST STE C
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9189
Practice Address - Country:US
Practice Address - Phone:608-636-4618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132038-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker