Basic Information
| Provider Information | |||||||||
| NPI: | 1679088512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | MEGGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2680 SNELLING AVE N STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551131879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513649381 | ||||||||
| FaxNumber: | 6517739115 | ||||||||
| Practice Location | |||||||||
| Address1: | 2680 SNELLING AVE N STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551131879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513649381 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2017 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 304583 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.