Individual
MS. ELIZABETH WALLEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
600 REED ST, SUITE 115, MANKATO, MN 56001-6410
(507) 625-4060
(507) 625-3915
Mailing address
125 VICTORIA BLVD, MANKATO, MN 56001-7100
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2168
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026L7WA
BXBS
MN
01
—
120012
UCARE MINNESOTA
MN
01
—
6273529
UNITED
MN
01
—
HP38262
HEALTH PARTNERS
FM
Enumeration date
05/13/2006
Last updated
07/09/2007
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