Individual
JODY WALLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
12915 63RD AVE N, MAPLE GROVE, MN 55369-6001
(952) 826-8465
Mailing address
12915 63RD AVE N, MAPLE GROVE, MN 55369-6001
(952) 826-8465
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
20641
MN
Other
Enumeration date
12/13/2013
Last updated
12/13/2013
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