Gregory David Walsh, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9379 Issued in MN

Practice address

1600 Arboretum Blvd
Suite # 211
Victoria, MN 55386-7705

Phone

(952) 443-3970

Fax

(952) 368-3177

NPI assigned

Jul 5, 2006

Last updated

Aug 11, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281484800000",
    "number": "1427089036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 82",
            "address_2": "VICTORIA MENTAL HEALTH SERVICES, LTD.",
            "city": "VICTORIA",
            "state": "MN",
            "postal_code": "553860082",
            "telephone_number": "952-443-3970",
            "fax_number": "952-368-3177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 ARBORETUM BLVD",
            "address_2": "SUITE # 211",
            "city": "VICTORIA",
            "state": "MN",
            "postal_code": "553867705",
            "telephone_number": "952-443-3970",
            "fax_number": "952-368-3177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "GREGORY",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2010-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "9379",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA-UBH",
            "identifier": "6236362",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0488739-00",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "048873900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristi L Taft, RN
• Drea Tuott
• Julie Van Beusekom, LICSW
• Victoria Orthodontics, LLC
• Mackenzie Wallace
• Stephanie Warner, MASSAGE THERAPIST
• Jordan Weitzel
• Mary Katherine Wheeler
• Kantarose Woolley
• Katie Mae Zavoral

• Clinical Social Worker in Victoria, MN
• Providers in Victoria, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.