Provider Demographics
NPI:1902348949
Name:WALLING, TAYLOR (LGSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WALLING
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:DIMMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:3 KEANU LN
Mailing Address - Street 2:
Mailing Address - City:ESKO
Mailing Address - State:MN
Mailing Address - Zip Code:55733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 KEANU LN
Practice Address - Street 2:
Practice Address - City:ESKO
Practice Address - State:MN
Practice Address - Zip Code:55733
Practice Address - Country:US
Practice Address - Phone:651-470-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23127104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker