Provider Demographics
NPI:1285389858
Name:WALKER, COREEN KIM ANDERSON (LADC)
Entity type:Individual
Prefix:
First Name:COREEN
Middle Name:KIM ANDERSON
Last Name:WALKER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 147TH ST W STE 204
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7850
Mailing Address - Country:US
Mailing Address - Phone:952-997-3020
Mailing Address - Fax:952-997-3026
Practice Address - Street 1:7300 147TH ST W STE 204
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7850
Practice Address - Country:US
Practice Address - Phone:952-997-3020
Practice Address - Fax:952-997-3026
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305904101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)