Provider Demographics
NPI:1033837075
Name:WALKER, MADELYN JEAN
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:JEAN
Last Name:WALKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MADELYN
Other - Middle Name:
Other - Last Name:FRANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 1ST AVENUE NORTH
Mailing Address - Street 2:APT. 205
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379
Mailing Address - Country:US
Mailing Address - Phone:320-200-4186
Mailing Address - Fax:
Practice Address - Street 1:1101 1ST AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379
Practice Address - Country:US
Practice Address - Phone:320-200-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MN33976104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician