Provider Demographics
NPI:1316062417
Name:WALSH, TERESA LEE (RT(R)(CI)(CV),CCRC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LEE
Last Name:WALSH
Suffix:
Gender:F
Credentials:RT(R)(CI)(CV),CCRC
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:LEE
Other - Last Name:VATTEROTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8775 RIVER HEIGHTS WAY
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-3477
Mailing Address - Country:US
Mailing Address - Phone:651-207-8181
Mailing Address - Fax:
Practice Address - Street 1:920 E 28TH ST
Practice Address - Street 2:SUITE 620
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1139
Practice Address - Country:US
Practice Address - Phone:612-863-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2016052471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography