Provider Demographics
NPI:1346400264
Name:WAHLQUIST, HAROLD (MA MDIV)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:
Last Name:WAHLQUIST
Suffix:
Gender:M
Credentials:MA MDIV
Other - Prefix:MR
Other - First Name:KIP
Other - Middle Name:G
Other - Last Name:WAHLQUIST
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MA MDIV
Mailing Address - Street 1:10800 LYNDALE AVE S
Mailing Address - Street 2:SUITE #191
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-5614
Mailing Address - Country:US
Mailing Address - Phone:952-884-5803
Mailing Address - Fax:
Practice Address - Street 1:10800 LYNDALE AVE S
Practice Address - Street 2:SUITE #191
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-5614
Practice Address - Country:US
Practice Address - Phone:952-884-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral